Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction

Alessandra Meris; Maria Amigoni; Anil Verma; Jens Jakob Thune; Lars Køber; Eric Velazquez; John J V McMurray; Marc A Pfeffer; Robert Califf; Paul Robert Levine; Scott D Solomon; Valsartan in Acute Myocardial Infarction (VALIANT) Investigators

doi:10.1016/j.echo.2012.01.006

Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction

Alessandra Meris, Maria Amigoni, Anil Verma, Jens Jakob Thune, Lars Køber, Eric Velazquez, John J V McMurray, Marc A Pfeffer, Robert Califf, Paul Robert Levine, Scott D Solomon, Valsartan in Acute Myocardial Infarction (VALIANT) Investigators

31 Citations (Scopus)

Abstract

Background: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up. Methods: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified. Results: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm ² was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months. Conclusions: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.

Original language	English
Journal	Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques
Volume	25
Issue number	5
Pages (from-to)	535-42
Number of pages	8
ISSN	0742-2822
DOIs	https://doi.org/10.1016/j.echo.2012.01.006
Publication status	Published - May 2012

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Meris, A., Amigoni, M., Verma, A., Thune, J. J., Køber, L., Velazquez, E., McMurray, J. J. V., Pfeffer, M. A., Califf, R., Levine, P. R., Solomon, S. D., & Valsartan in Acute Myocardial Infarction (VALIANT) Investigators (2012). Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction. Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques, 25(5), 535-42. https://doi.org/10.1016/j.echo.2012.01.006

Meris, A, Amigoni, M, Verma, A, Thune, JJ, Køber, L, Velazquez, E, McMurray, JJV, Pfeffer, MA, Califf, R, Levine, PR, Solomon, SD & Valsartan in Acute Myocardial Infarction (VALIANT) Investigators 2012, 'Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction', Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques, vol. 25, no. 5, pp. 535-42. https://doi.org/10.1016/j.echo.2012.01.006

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title = "Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction",

abstract = "Background: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up. Methods: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified. Results: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm 2 was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months. Conclusions: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.",

author = "Alessandra Meris and Maria Amigoni and Anil Verma and Thune, {Jens Jakob} and Lars K{\o}ber and Eric Velazquez and McMurray, {John J V} and Pfeffer, {Marc A} and Robert Califf and Levine, {Paul Robert} and Solomon, {Scott D} and K{\o}ber, {Lars Valeur}",

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doi = "10.1016/j.echo.2012.01.006",

language = "English",

volume = "25",

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T1 - Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction

AU - Meris, Alessandra

AU - Amigoni, Maria

AU - Verma, Anil

AU - Thune, Jens Jakob

AU - Køber, Lars

AU - Velazquez, Eric

AU - McMurray, John J V

AU - Pfeffer, Marc A

AU - Califf, Robert

AU - Levine, Paul Robert

AU - Solomon, Scott D

AU - Valsartan in Acute Myocardial Infarction (VALIANT) Investigators

PY - 2012/5

Y1 - 2012/5

N2 - Background: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up. Methods: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified. Results: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm 2 was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months. Conclusions: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.

AB - Background: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up. Methods: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified. Results: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm 2 was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months. Conclusions: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.

U2 - 10.1016/j.echo.2012.01.006

DO - 10.1016/j.echo.2012.01.006

M3 - Journal article

C2 - 22305962

SN - 0742-2822

VL - 25

SP - 535

EP - 542

JO - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

JF - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

IS - 5

ER -

Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction

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