title: The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction.
abstract: The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Jung Sun
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Her
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Maen Won
authors.initials: MW
authors.lastname: Park
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Chan Joon
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea. ; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea.
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea.
authors.forename: Chong Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea.
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea.
authors.forename: Kyoo Rok
authors.initials: KR
authors.lastname: Han
authors.affiliation: Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea.
authors.forename: Hyo Soo
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000473:pathology*; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Acute Myocardial Infarction; Left Ventricular Ejection Fraction; Mitral Regurgitation