Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania -
Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Minerva Cardioangiol. 2020 Jun;68(3):237-245. doi: 10.23736/S0026-4725.20.05021-5. Epub 2020 Feb 20.
Ischemic mitral regurgitation (IMR) is a frequent valvular heart disease and is related to worse prognosis. The aim of this study was to investigate the dynamics in the degree of IMR from the acute phase of inferoposterior myocardial infarction (MI) to 5-years follow-up and to identify the predictors of change in the degree of mitral regurgitation (MR).
We included patients with first ever acute inferoposterior MI and examined them in two phases: at the time of acute MI then 5 years later. Based on two-dimensional transthoracic echocardiography, the patients were divided into the non-significant MR (NMR) group and IMR group. The parameters of left ventricle (LV), mitral apparatus and clinical data were assessed in both phases. The predictors of a decrease or an increase in the degree of mitral regurgitation after 5 years were identified.
The values of the parameters of mitral apparatus and LV chambers increased with higher degrees of IMR. The tenting height, systolic blood pressure and posteromedial papillary muscle (PMPM) displacement during the acute phase were the most important in predicting the change in the degree of MR after 5 years.
The assessment of mitral apparatus in acute phase of MI can be most useful to determine the change of the degree of MR long-term post MI. Although LV remodelling itself contributes to IMR, this influence is directly dependent on alterations in mitral geometry.
缺血性二尖瓣反流（IMR）是一种常见的心脏瓣膜病，与预后较差有关。本研究旨在探讨从急性下壁心肌梗死（MI）到 5 年随访期间 IMR 程度的动态变化，并确定二尖瓣反流（MR）程度变化的预测因素。
我们纳入了首次急性下壁 MI 的患者，并在两个阶段对其进行检查：急性 MI 时和 5 年后。根据二维经胸超声心动图，患者分为非显著 MR（NMR）组和 IMR 组。在两个阶段评估左心室（LV）、二尖瓣装置和临床数据的参数。确定 5 年后二尖瓣反流程度降低或增加的预测因素。
随着 IMR 程度的增加，二尖瓣装置和 LV 腔室的参数值也随之增加。急性阶段的瓣叶游离缘抬高高度、收缩压和后内侧乳头肌（PMPM）位移是预测 5 年后 MR 程度变化的最重要因素。
在 MI 的急性阶段评估二尖瓣装置对于确定 MI 后长期 MR 程度的变化最有用。尽管 LV 重构本身会导致 IMR，但这种影响直接取决于二尖瓣几何形状的改变。
