A longitudinal study of mitral regurgitation detected after acute myocardial infarction
<strong>Background:</strong> Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical out...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
MDPI
2022
|
| _version_ | 1826307773850189824 |
|---|---|
| author | Sharma, H Yuan, M Shakeel, I Hodson, J Radhakrishnan, A Brown, S May, J O'Connor, K Zia, N Doshi, SN Hothi, SS Townend, JN Myerson, SG Ludman, PF Steeds, RP Nadir, MA |
| author_facet | Sharma, H Yuan, M Shakeel, I Hodson, J Radhakrishnan, A Brown, S May, J O'Connor, K Zia, N Doshi, SN Hothi, SS Townend, JN Myerson, SG Ludman, PF Steeds, RP Nadir, MA |
| author_sort | Sharma, H |
| collection | OXFORD |
| description | <strong>Background:</strong> Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical outcomes following MI.
<br>
<strong>Methods:</strong> Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined.
<br>
<strong>Results:</strong> 294/1000 consecutive patients had MR on baseline (pre-discharge) transthoracic echocardiography (TTE), of whom 126 (mean age: 70.9 ± 11.4 years) had at least one follow-up TTE. At baseline, most patients had mild MR (n = 94; 75%), with n = 30 (24%) moderate and n = 2 (2%) severe MR. Significant improvement in MR was observed at the first follow-up TTE (median 9 months from baseline; interquartile range: 3–23), with 36% having reduced severity, compared to 10% having increased MR severity (p < 0.001). Predictors of worsening MR included older age (mean: 75.2 vs. 66.7 years; p = 0.003) and lower creatinine clearance (mean: 60 vs. 81 mL/min, p = 0.015). Change in MR severity was significantly associated with prognosis: 16% with improving MR reached the composite endpoint of death or heart failure hospitalisation at 5 years, versus 44% (p = 0.004) with no change, and 59% (p < 0.001) with worsening MR.
<br>
<strong>Conclusions:</strong> Of patients with follow-up TTE after MI, MR severity improved from baseline in approximately one-third, was stable in around half, with the remainder having worsening MR. Patients with persistent or worsening MR had worse clinical outcomes than those with improving MR. |
| first_indexed | 2024-03-07T07:08:08Z |
| format | Journal article |
| id | oxford-uuid:aac9405d-1d08-42a9-be77-e562fbde2234 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:08:08Z |
| publishDate | 2022 |
| publisher | MDPI |
| record_format | dspace |
| spelling | oxford-uuid:aac9405d-1d08-42a9-be77-e562fbde22342022-05-23T09:57:33ZA longitudinal study of mitral regurgitation detected after acute myocardial infarctionJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:aac9405d-1d08-42a9-be77-e562fbde2234EnglishSymplectic ElementsMDPI2022Sharma, HYuan, MShakeel, IHodson, JRadhakrishnan, ABrown, SMay, JO'Connor, KZia, NDoshi, SNHothi, SSTownend, JNMyerson, SGLudman, PFSteeds, RPNadir, MA<strong>Background:</strong> Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical outcomes following MI. <br> <strong>Methods:</strong> Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined. <br> <strong>Results:</strong> 294/1000 consecutive patients had MR on baseline (pre-discharge) transthoracic echocardiography (TTE), of whom 126 (mean age: 70.9 ± 11.4 years) had at least one follow-up TTE. At baseline, most patients had mild MR (n = 94; 75%), with n = 30 (24%) moderate and n = 2 (2%) severe MR. Significant improvement in MR was observed at the first follow-up TTE (median 9 months from baseline; interquartile range: 3–23), with 36% having reduced severity, compared to 10% having increased MR severity (p < 0.001). Predictors of worsening MR included older age (mean: 75.2 vs. 66.7 years; p = 0.003) and lower creatinine clearance (mean: 60 vs. 81 mL/min, p = 0.015). Change in MR severity was significantly associated with prognosis: 16% with improving MR reached the composite endpoint of death or heart failure hospitalisation at 5 years, versus 44% (p = 0.004) with no change, and 59% (p < 0.001) with worsening MR. <br> <strong>Conclusions:</strong> Of patients with follow-up TTE after MI, MR severity improved from baseline in approximately one-third, was stable in around half, with the remainder having worsening MR. Patients with persistent or worsening MR had worse clinical outcomes than those with improving MR. |
| spellingShingle | Sharma, H Yuan, M Shakeel, I Hodson, J Radhakrishnan, A Brown, S May, J O'Connor, K Zia, N Doshi, SN Hothi, SS Townend, JN Myerson, SG Ludman, PF Steeds, RP Nadir, MA A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title | A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title_full | A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title_fullStr | A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title_full_unstemmed | A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title_short | A longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| title_sort | longitudinal study of mitral regurgitation detected after acute myocardial infarction |
| work_keys_str_mv | AT sharmah alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT yuanm alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT shakeeli alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT hodsonj alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT radhakrishnana alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT browns alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT mayj alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT oconnork alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT zian alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT doshisn alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT hothiss alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT townendjn alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT myersonsg alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT ludmanpf alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT steedsrp alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT nadirma alongitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT sharmah longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT yuanm longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT shakeeli longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT hodsonj longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT radhakrishnana longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT browns longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT mayj longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT oconnork longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT zian longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT doshisn longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT hothiss longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT townendjn longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT myersonsg longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT ludmanpf longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT steedsrp longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction AT nadirma longitudinalstudyofmitralregurgitationdetectedafteracutemyocardialinfarction |