首次急性心肌梗死后缺血性二尖瓣反流的发生率及其与梗死部位和院内死亡率的关系。
Frequency of ischemic mitral regurgitation after first-time acute myocardial infarction and its relation to infarct location and in-hospital mortality.
作者信息
Fazlinezhad Afsoon, Dorri Mitra, Azari Ali, Bigdelu Leila
机构信息
Cardiovascular Research Center, Mashhad University of Medical Science, Mashhad, Iran.
Torbat Jam Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
J Tehran Heart Cent. 2014;9(4):160-5. Epub 2014 Jul 6.
BACKGROUND
Ischemic mitral regurgitation (IMR) is a common complication after acute myocardial infarction (AMI). We aimed to investigate the frequency of IMR following first-time AMI and its association with infarct location, in-hospital mortality, and complications.
METHODS
From September 2011 to November 2012, all patients with a diagnosis of first-time acute ST-elevation MI were enrolled in the study. Patients with previous MI and heart failure, organic mitral valve disorders, and previous mitral surgery were excluded from the study. The patients' baseline characteristic, echocardiographic parameters, and complications were recorded. The frequency of IMR after AMI and its relation to infarct location and in-hospital mortality were evaluated.
RESULTS
Altogether, 250 patients (180 male) at a mean age of 60.21 ± 12.90 years were studied. IMR was detected in 114 (45%) patients. There was no association between the presence of MR and gender, systemic hypertension, smoking, diabetes mellitus, or body mass index; however, serum LDL-cholesterol and triglyceride levels were significantly higher in the patients with IMR . The most frequent territory of MI was anterior in the patients without MR, while the anterolateral territory was the most common one in the patients with IMR. The patients with IMR had more reduced left ventricular ejection fraction, more elevated left ventricular end-diastolic pressure, and higher pulmonary arterial pressure (p values < 0.001, < 0.001, and < 0.001, respectively). Stage III diastolic dysfunction was more frequent in the patients with IMR. All the deaths occurred in the IMR patients, who also had more complicated AMI.
CONCLUSION
IMR following AMI is highly prevalent, and it complicates about half of the patients. Regarding its relation to the AMI complications, assessment of the MR severity is necessary to make an appropriate decision for treatment.
背景
缺血性二尖瓣反流（IMR）是急性心肌梗死（AMI）后常见的并发症。我们旨在研究首次AMI后IMR的发生率及其与梗死部位、院内死亡率和并发症的关系。
方法
2011年9月至2012年11月，所有诊断为首次急性ST段抬高型心肌梗死的患者均纳入本研究。既往有心肌梗死和心力衰竭、器质性二尖瓣疾病及既往二尖瓣手术史的患者被排除在研究之外。记录患者的基线特征、超声心动图参数及并发症情况。评估AMI后IMR的发生率及其与梗死部位和院内死亡率的关系。
结果
共研究了250例患者（180例男性），平均年龄为60.21±12.90岁。114例（45%）患者检测到IMR。MR的存在与性别、系统性高血压、吸烟、糖尿病或体重指数之间无关联；然而，IMR患者的血清低密度脂蛋白胆固醇和甘油三酯水平显著更高。无MR患者中最常见的心肌梗死区域为前壁，而IMR患者中最常见的是前外侧壁。IMR患者的左心室射血分数降低更明显，左心室舒张末期压力升高更明显，肺动脉压更高（p值分别<0.001、<0.001和<0.001）。IMR患者中III期舒张功能障碍更常见。所有死亡均发生在IMR患者中，这些患者的AMI也更复杂。
结论
AMI后的IMR非常普遍，约半数患者会出现该并发症。关于其与AMI并发症的关系，有必要评估MR的严重程度以便做出合适的治疗决策。
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