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Doron Aronson, MD; Noa Goldsher, BsC; Robert Zukermann, MD; Michael Kapeliovich, MD, PhD; Jonathan Lessick, MD, DSc; Diab Mutlak, MD; Salim Dabbah, MD; Walter Markiewicz, MD; Rafael Beyar, MD, DSc; Haim Hammerman, MD; Shimon Reisner, MD; Yoram Agmon, MD

Arch Intern Med. 2006;166:2362-2368.

Background  The development of ischemic mitral regurgitation (MR) after myocardial infarction may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). However, few data are available on the relationship between ischemic MR and the long-term risk for HF.

Methods  We prospectively studied 1190 patients admitted for acute myocardial infarction. Mitral regurgitation was assessed by echocardiography and was considered mild, moderate, and severe when the regurgitant jet area occupied less than 20%, 20% to 40%, and greater than 40% of the left atrial area, respectively. The median duration of follow-up was 24 months (range, 6-48 months).

Results  Mild and moderate or severe ischemic MR was present in 39.7% and 6.3% of patients, respectively. After adjusting for ejection fraction and clinical variables (age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior infarction, ST-elevation infarction, and coronary revascularization), compared with patients without MR, the hazard ratios for HF were 2.8 (95% confidence interval [CI], 1.8-4.2; P<.001) and 3.6 (95% CI, 2.0-6.4; P<.001) in patients with mild and moderate or severe ischemic MR, respectively. The adjusted hazard ratios for death were 1.2 (95% CI, 0.8-1.8; P = .43) and 2.0 (95% CI, 1.2-3.4; P = .02) in patients with mild and moderate or severe MR, respectively.

Conclusions  There is a graded independent association between the severity of ischemic MR and the development of HF after myocardial infarction. Even mild ischemic MR is associated with an increase in the risk of HF.

Author Affiliations: Department of Cardiology, Rambam Medical Center and Rappaport Medical School, Haifa, Israel.

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