Sharma Harish, Yuan Mengshi, Shakeel Iqra, Hodson James, Radhakrishnan Ashwin, Brown Samuel, May John, O'Connor Kieran, Zia Nawal, Doshi Sagar N, Hothi Sandeep S, Townend Jonathan N, Myerson Saul G, Ludman Peter F, Steeds Richard P, Nadir M Adnan
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
Department of Cardiology, University Hospitals Birmingham, Birmingham B15 2TH, UK.
J Clin Med. 2022 Feb 13;11(4):965. doi: 10.3390/jcm11040965.
Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical outcomes following MI.
Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined.
294/1000 consecutive patients had MR on baseline (pre-discharge) transthoracic echocardiography (TTE), of whom 126 (mean age: 70.9 ± 11.4 years) had at least one follow-up TTE. At baseline, most patients had mild MR ( = 94; 75%), with = 30 (24%) moderate and = 2 (2%) severe MR. Significant improvement in MR was observed at the first follow-up TTE (median 9 months from baseline; interquartile range: 3-23), with 36% having reduced severity, compared to 10% having increased MR severity ( < 0.001). Predictors of worsening MR included older age (mean: 75.2 vs. 66.7 years; = 0.003) and lower creatinine clearance (mean: 60 vs. 81 mL/min, = 0.015). Change in MR severity was significantly associated with prognosis: 16% with improving MR reached the composite endpoint of death or heart failure hospitalisation at 5 years, versus 44% ( = 0.004) with no change, and 59% ( < 0.001) with worsening MR.
Of patients with follow-up TTE after MI, MR severity improved from baseline in approximately one-third, was stable in around half, with the remainder having worsening MR. Patients with persistent or worsening MR had worse clinical outcomes than those with improving MR.
心肌梗死（MI）后二尖瓣反流（MR）很常见。然而，MR随后的发展轨迹及其对长期预后的影响尚不清楚。本研究旨在探讨MI后MR严重程度的变化及相关临床结局。
回顾性研究2016年至2017年间在单一中心因急性心肌梗死接受经皮冠状动脉介入治疗（PCI）的患者记录。
在基线（出院前）经胸超声心动图（TTE）检查中，294/1000例连续患者存在MR，其中126例（平均年龄：70.9±11.4岁）至少接受了一次随访TTE检查。基线时，大多数患者为轻度MR（n = 94；75%），30例（24%）为中度MR，2例（2%）为重度MR。在首次随访TTE时（中位数为基线后9个月；四分位间距：3 - 23个月）观察到MR有显著改善，36%的患者严重程度降低，而MR严重程度增加的患者为10%（P < 0.001）。MR恶化的预测因素包括年龄较大（平均：75.2岁对66.7岁；P = 0.003）和肌酐清除率较低（平均：60对81 mL/分钟，P = 0.015）。MR严重程度的变化与预后显著相关：MR改善的患者中有16%在5年时达到死亡或因心力衰竭住院的复合终点，而无变化的患者为44%（P = 0.004），MR恶化的患者为59%（P < 0.001）。
在MI后接受随访TTE检查的患者中，约三分之一的患者MR严重程度较基线有所改善，约一半患者病情稳定，其余患者MR病情恶化。持续或恶化的MR患者的临床结局比改善的患者更差。
