Frequency of Mitral Regurgitation in Patients with Acute Myocardial Infarction
Keywords:Acute MI, mitral regurgitation, anterior and inferior wall MI.
BACKGROUND: Mechanical complications can occur after acute myocardial infarction. Most commonly mitral regurgitation (MR) occurs after infero-basal myocardial infarction (MI) due to papillary muscles dysfunction. MR may also develop with antero-apical MI. The objective of the study was to determine the frequency of mitral regurgitation in acute MI patients and to risk stratify the patients with MR for anterior and inferior wall MI.
AIMS & OBJECTIVE: To assess the frequency of mitral regurgitation in patients with acute myocardial infarction.
MATERIAL & METHODS: This was a descriptive case series carried out at the Cardiology department of Jinnah Hospital, Lahore from: 29-10-2013 to 29-04-2014. A total of 340 patients of MI were included. Echocardiography examination was carried out on all subjects on day 3-4 post MI. Frequency of mitral regurgitation in each group was measured by color flow Doppler technique.
RESULTS: Out of study population, 153 (45%) were in between 30-50 years and 187 (55%) were in between 51-75 years. The mean of age was calculated as 55.09+11.81 years. In our data 181 (53.24%) were male and 159 (46.76%) were female. Frequency of MR in acute MI patients was recorded in 69 (20.29%) while 271 (79.71%) had no findings of MR. From the total of 69 cases, MR was recorded in 13 (18.84%) as anterior wall MI and 16 (23.19%) as inferior wall MI, p value was calculated as 0.532 which shows insignificant difference. There was a significant difference in hospital stay and mortality between both groups p-value 0.04.
CONCLUSION: Mechanical complications develop after acute myocardial infarction and may be associated with serious outcomes.
KEYWORDS: Acute MI, mitral regurgitation, anterior and inferior wall MI.
Harrison TR. Valvular heart diseases editors. In: Longo DL. Harrison’s principles of Internal Medicine 17ed. New York: Mc Graw Hill; 2008. p.1469
Yosefy C, Beeri R, Guerrero JL. Mitral Regurgitation after Anteroapical Myocardial Infarction; New Mechanistic insights. Circulation 2011;123:1529-36.
Agricola E, Oppizzi M, Pisani M et al. Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Eur Heart J Cardiovasc Imaging 2008;9:207-21.
Lancellotti P, Moura L, Pierard LA et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease) Eur J Echo 2010;11:307–32.
Lancellotti P, Tribouilloy C, Hagendorff A. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease) Eur J Echo 2010;11:223-44.
Pierard LA, Carabello BA. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment. Eur Heart J 2010;31:2996–3005.
Mudrick DW, Reed SD, Li Y. Mitral regurgitation after myocardial infarction predicts increased medical costs and decreased quality of life. J Am Coll Cardiol 2010;55:1174-9.
Persson A, Hartford M, Herlitz J. Long-term prognostic value of mitral regurgitation in acute coronary syndromes. Heart 2010;96:1803-8.
Sarano ME, Akins CW, Vahanian A. Mitral regurgitation. The Lancet 2009;373:1382-94.
Sobelga AL, Muniak EW, Kostkiewicz M. Chronic ischaemic mitral regurgitation: the comparison between the anterior and inferior myocardial infarction: echocardiography and cardiac magnetic resonance study. Eur J Echo Abstracts 2010:2:408-9.
Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg. 2003 Jan;125(1):135-43.
Hashemi A, Hashemi A, Peizhamberi MM, Alizadehas A. Frequency of Mitral regurgitation in patients with acute first ST-elevation Myocardial infarction and its relationship with location of MI. Iran Heart J 2013;13(2):37-42.
Gorman RC, Gorman JH, Edmunds L. Ischemic Mitral regurgitation In: Cohn LH, Edmunds LH jr, Cardiac Surgery in the Adult,5th ed. Mcgraw-Hill, New York, 2003;751-69.
Bursi F, Enriquez-Sarano M, Jacobsen SJ, Roger VL. Mitral regurgitation after myocardial infarction: a review. Am J Med 2006;119-(2),103-12.
Gillinov AM, Wierup PN, Blackstone EH. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 2001;122:1125.
Llaneras MR, Nance ML, Streicher JT. Pathogenesis of ischemic mitral insufficiency. J Thorac Cardiovasc Surg 1993;105:439043.
GromanRC, Mc Caughan JS, Rateliffe MB. Pathogenesis of acute ischemic mitral regurgitation in three dimensions. J Thorac Cardiovasc Surg 1995;109:684-7.
Gorman JH 3rd, Gorman RC, Plappert T. Infarct size and location determine development of mitral regurgitation in the sheep model. J Thorac Cardoivasc Surg 1998;115,615-22.
Birnbaum Y, Chamoun AJ, Conti VR, Urestsky BF. Mitral regurgitation following acute myocardial infarction. Coronary Artery Dis 2002;13(6):337-44.