title: Predicting ischemic mitral regurgitation in patients with acute ST-elevation myocardial infarction: Does time to reperfusion really matter and what is the role of collateral circulation?
abstract: OBJECTIVE
  Ischemic mitral regurgitation (MR) is an adverse prognostic factor. We aimed to assess the role of time delay from symptom onset to reperfusion, and the impact of collateral circulation to incidence of MR in relation to established echocardiographic and clinical risk factors.
  
  
  METHODS
  Patients with STEMI presenting within 12 h from symptom onset and treated with primary percutaneous coronary intervention (PPCI) at Hospital of Lithuanian University of Health Sciences were enrolled. Echocardiography was performed after PPCI. Based on MR grade, patients were divided into no significant MR (NMR, grade 0-I MR, N = 102) and ischemic MR (IMR, grade ≥ 2 MR, N = 71) groups. Well-developed collaterals were defined as grade ≥ 2 by Rentrop classification. Continuous variables were compared by independent samples Student's T-test. Multivariate logistic regression analysis was used to identify independent predictors of ischemic MR.
  
  
  RESULTS
  Time to reperfusion, MI localization, TIMI flow before/after PCI was similar between the groups. IMR group patients were elder, more often females and non-smokers, had lower body mass index, higher prevalence of multi-vessel coronary artery disease (CAD), better-developed collateral supply, greater left ventricular end-diastolic diameter index, left atrial index, pulmonary artery systolic pressure and lower ejection fraction. Multivariate logistic regression analysis revealed that ischemic MR is predicted by female gender, well-developed collateral supply, presence of multi-vessel CAD, and lower EF.
  
  
  CONCLUSIONS
  In acute STEMI significant MR is unrelated to ischemic time and is predicted by female gender, lower EF, multi-vessel CAD and well-developed collateral supply to the infarct region.
authors.affiliation: Department of Cardiology, Lithuanian University of Health Sciences, Lithuania. Electronic address: z.valuckiene@gmail.com.
authors.forename: Zivile
authors.initials: Z
authors.lastname: Valuckiene
authors.affiliation: Faculty of Medicine, Lithuanian University of Health Sciences, Lithuania.
authors.forename: Povilas
authors.initials: P
authors.lastname: Budrys
authors.affiliation: Department of Cardiology, Lithuanian University of Health Sciences, Lithuania.
authors.forename: Renaldas
authors.initials: R
authors.lastname: Jurkevicius
mesh_terms: D000368:Aged; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008097:Lithuania / Q000453:epidemiology; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Collateral circulation; Mitral regurgitation; Reperfusion time