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. 2010 Nov;96(22):1803-8.
doi: 10.1136/hrt.2010.203059. Epub 2010 Sep 28.

Long-term prognostic value of mitral regurgitation in acute coronary syndromes

Anita Persson  1 , Marianne Hartford, Johan Herlitz, Thomas Karlsson, Torbjørn Omland, Kenneth Caidahl
Affiliations

Long-term prognostic value of mitral regurgitation in acute coronary syndromes

Anita Persson et al. Heart. 2010 Nov.

Abstract

Objectives: To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS).

Design: Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA.

Setting: Single-centre university hospital.

Patients: 725 patients with ACS.

Main outcome measures: Death and readmission for congestive heart failure.

Results: During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003).

Conclusions: MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Kaplan–Meier curves showing the cumulative incidence of death in relation to (A) mitral regurgitation (MR) grade >1 or ≤1; (B) left ventricular ejection fraction (LVEF) <0.40 or ≥0.40; and (C) B-type natriuretic peptide (BNP) >373 pmol/l (75th percentile) or ≤373 pmol/l in patients with acute coronary syndromes.
Figure 2
Figure 2
Cumulative incidence of death in relation to (A) risk score 0, 1 and 2–3 where mitral regurgitation (MR) grade >1, left ventricular ejection fraction (LVEF) <0.40 and BNP >373 pmol/l (75th percentile) yielded one score point each; and (B) risk score 0, 1 and 2 where MR grade >1 and LVEF <0.40 contributed one score point each.
See this image and copyright information in PMC

References

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