Cardiovascular Institute, Hospital Clínico San Carlos, , Madrid, Spain.
Heart. 2013 Oct;99(20):1502-8. doi: 10.1136/heartjnl-2013-304298. Epub 2013 Aug 19.
To assess the relationship between functional mitral regurgitation (MR) after a non-ST segment elevation acute coronary syndrome (NSTSEACS) and long-term prognosis, ventricular remodelling and further development of atrial fibrillation (AF), since functional MR is common after myocardial infarction.
Prospective cohort study conducted in a tertiary referral centre.
We prospectively studied 237 patients consecutively discharged in New York Heart Association class I-II (74% men; mean age 66.1 years) after a first NSTSEACS. All underwent an ECG the first week after admission and were echocardiographically and clinically followed-up (median 6.95 years).
MR was detected in 95 cases (40.1%) and became an independent risk factor for the development of heart failure (HF) and major adverse cardiovascular events (MACE) (per MR degree, HRHF 1.71, 95% CI 1.138 to 2.588, p=0.01; HRMACE 1.49, 95% CI 1.158 to 1.921, p=0.002). Left ventricular diastolic (grade I 12.7±40.7; grade II 26.8±12.4; grade III 46.3±50.9 mL, p=0.01) and systolic (grade I 10.4±37.3; grade II 10.12±12.7; grade III 36.8±46.0 mL, p=0.02) mean volumes were higher after follow-up in patients with MR, in proportion to the initial degree of MR. In the rhythm analysis (126 patients; previously excluding those with any history of AF) during follow-up, 11.4% of patients with degree I MR, 14.3% with degree II MR and 75% with degree III MR developed AF, while only 5.1% of those with degree 0 developed AF, p<0.001.
MR is common after an NSTSEACS. The presence and greater degree of MR confers a worse long-term prognosis after a first NSTSEACS. This can in part be explained by increased negative ventricular remodelling and increased occurrence of AF.
评估非 ST 段抬高型急性冠状动脉综合征（NSTSEACS）后功能性二尖瓣反流（MR）与长期预后、心室重构和心房颤动（AF）进一步发展之间的关系，因为心肌梗死后功能性 MR 很常见。
在三级转诊中心进行的前瞻性队列研究。
我们前瞻性地研究了 237 例连续出院的 I 级- II 级纽约心脏协会（74%男性；平均年龄 66.1 岁）的首次 NSTSEACS 患者。所有患者入院后第一周均接受心电图检查，并进行超声心动图和临床随访（中位随访时间 6.95 年）。
95 例（40.1%）患者检测到 MR，并成为心力衰竭（HF）和主要不良心血管事件（MACE）发生的独立危险因素（每增加 1 个 MR 程度，HF 的 HR 为 1.71，95%CI 为 1.138 至 2.588，p=0.01；MACE 的 HR 为 1.49，95%CI 为 1.158 至 1.921，p=0.002）。MR 患者左心室舒张末期（I 级 12.7±40.7；II 级 26.8±12.4；III 级 46.3±50.9 mL，p=0.01）和收缩末期（I 级 10.4±37.3；II 级 10.12±12.7；III 级 36.8±46.0 mL，p=0.02）平均容积在随访后更高，与初始 MR 程度成正比。在随访期间的节律分析（126 例；之前排除任何 AF 病史的患者）中，I 级 MR 患者中有 11.4%、II 级 MR 患者中有 14.3%和 III 级 MR 患者中有 75%发生了 AF，而只有 5.1%的 0 级 MR 患者发生了 AF，p<0.001。
NSTSEACS 后功能性 MR 很常见。MR 的存在和更大程度预示着首次 NSTSEACS 后预后更差。这在一定程度上可以解释为负性心室重构增加和 AF 发生率增加。
