Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

Cardiovascular Ultrasound

Research

Éric Larose¹  Jimmy MacHaalany¹  Olivier F Bertrand¹  Kim O’Connor¹  Olivier Costerousse¹  Eltigani Abdelaal¹  Jean-Pierre Déry¹  Mario Sénéchal¹  Pierre Voisine²  Éric Charbonneau² 

[1] Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 chemin Sainte-Foy, G1V 4G5, Quebec City, Quebec, Canada;Department of Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada;

关键词: Ischemic mitral regurgitation;    Mitral valve;    Primary percutaneous coronary intervention;    Myocardial infarction;   

DOI  :  10.1186/1476-7120-12-14

 received in 2014-01-30, accepted in 2014-03-10,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundStudies assessing ischemic mitral regurgitation (IMR) comprised of heterogeneous population and evaluated IMR in the subacute setting. The incidence of early IMR in the setting of primary PCI, its progression and clinical impact over time is still undetermined. We sought to determine the predictors and prognosis of early IMR after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).MethodsUsing our primary PCI database, we screened for patients who underwent ≥2 transthoracic echocardiograms early (1–3 days) and late (1 year) following primary PCI. The primary outcomes were: (1) major adverse events (MACE) including death, ischemic events, repeat hospitalization, re-vascularization and mitral repair or replacement (2) changes in quantitative echocardiographic assessments.ResultsFrom January 2006 to July 2012, we included 174 patients. Post-primary PCI IMR was absent in 95 patients (55%), mild in 60 (34%), and moderate to severe in 19 (11%). Early after primary PCI, IMR was independently predicted by an ischemic time > 540 min (OR: 2.92 [95% CI, 1.28 – 7.05]; p = 0.01), and female gender (OR: 3.06 [95% CI, 1.42 – 6.89]; p = 0.004). At a median follow-up of 366 days [34–582 days], IMR was documented in 44% of the entire cohort, with moderate to severe IMR accounting for 15%. During follow-up, MR regression (change ≥ 1 grade) was seen in 18% of patients. Moderate to severe IMR remained an independent predictor of MACE (HR: 2.58 [95% CI, 1.08 – 5.53]; p = 0.04).ConclusionsAfter primary PCI, IMR is a frequent finding. Regression of early IMR during long-term follow-up is uncommon. Since moderate to severe IMR post-primary PCI appears to be correlated with worse outcomes, close follow-up is required.

【 授权许可】

Unknown   
© MacHaalany et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.