TY - JOUR
T1 - Improved posterobasal segment function after thrombolysis is associated with decreased incidence of significant mitral regurgitation in a first inferior myocardial infarction
AU - Tenenbaum, Alexander
AU - Leor, Jonathan
AU - Motro, Michael
AU - Hod, Hanoch
AU - Kaplinsky, Elieser
AU - Rabinowitz, Babeth
AU - Boyko, Valentina
AU - Vered, Zvi
N1 - Funding Information:
New mitral regurgitation in acute myocardial infarction, defined as valve incompetence with no primary leaflet or chordal abnormalities, is associated with the development of hemodynamic deterioration and increased mortality (1-7). This disorder is a relatively common complication of acute ischemia and frequently occurs in patients with inferior or posterior myocardial infarction (4,5,8). Recent reports (3-5,9-11) suggest that the incidence of ischemic mitral regurgitation is 9% to 56%. Ischemic mitral regurgitation has traditionally been ascribed to "papillary muscle dysfunction." Originally, Burch et al. (12) proposed that papillary muscle dysfunction could be due to either mitral valve prolapse or incomplete mitral valve closure. Subsequent studies suggested additional mechanisms for mitral valve incompetence in acute myocardial infarction: mitral annulus dilation (5,13) and left ventricular dilation (5,11,14) or FromT he HeartI nstitute,S hebaM edicalC enter,T el Hashomera nd Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. This work was supported in part by Grant 768/92 to Dr. Vered from the ScienceF oundation, National Academyo f Sciencesa nd Humanities,J erusalem, Israel. Manuscript receivedO ctober2 0, 1994;r evisedm anuscriptr eceivedJ anuary 11, 1995, acceptedJ anuary 19, 1995.
PY - 1995/6
Y1 - 1995/6
N2 - Objectives. This study was designed to investigate the association between wall motion abnormalities and the occurrence of ischemic mitral regurgitation in patients with a first inferior or posterior myocardial infarction and to reassess the role of thrombolytic treatment in these patients. Background. We previously demonstrated that thrombolytic therapy reduces the incidence of significant mitral regurgitation in patients with a first inferior myocardial infarction, but the mechanisms responsible for this decrease were not clear. Methods. Wall motion score on two-dimensional echocardiography (16 segments) and mitral regurgitation grade (0 to 3) on Doppler color flow imaging were assessed in 95 patients (in 47 after thrombolysis) at 24 h, 7 to 10 days and 1 month after myocardial infarction. Significant mitral regurgitation was defined as moderate or severe (grade 2 or 3). Results. Multivariate analysis revealed that the presence of an advanced wall motion abnormality of the posterobasal segment of the left ventricle was the most significant independent variable associated with significant mitral regurgitation: odds ratio (OR) 15.0, 90% confidence interval (CI) 1.4 to 165.6 at 24 h; OR 2.8, CI 0.9 to 9.3 at 7 to 10 days; OR 4.2, CI 1.2 to 11.4 at 1 month. Thrombolysis reduced the prevalence of advanced wall motion abnormalities in the posterobasal segment at 24 h (55% vs. 75%, OR 0.5, CI 0.2 to 0.99), 7 to 10 days (44% vs. 73%, OR 0.3, CI 0.1 to 0.7) and 1 month (36% vs. 56%, OR 0.4, CI 0.2 to 0.9). Conclusions. There is a strong association between advanced wall motion abnormalities in the posterobasal segment and significant mitral regurgitation. In this study group, thrombolysis reduced the prevalence of advanced wall motion abnormalities in the posterobasal segment and thereby reduced the incidence of significant mitral regurgitation.
AB - Objectives. This study was designed to investigate the association between wall motion abnormalities and the occurrence of ischemic mitral regurgitation in patients with a first inferior or posterior myocardial infarction and to reassess the role of thrombolytic treatment in these patients. Background. We previously demonstrated that thrombolytic therapy reduces the incidence of significant mitral regurgitation in patients with a first inferior myocardial infarction, but the mechanisms responsible for this decrease were not clear. Methods. Wall motion score on two-dimensional echocardiography (16 segments) and mitral regurgitation grade (0 to 3) on Doppler color flow imaging were assessed in 95 patients (in 47 after thrombolysis) at 24 h, 7 to 10 days and 1 month after myocardial infarction. Significant mitral regurgitation was defined as moderate or severe (grade 2 or 3). Results. Multivariate analysis revealed that the presence of an advanced wall motion abnormality of the posterobasal segment of the left ventricle was the most significant independent variable associated with significant mitral regurgitation: odds ratio (OR) 15.0, 90% confidence interval (CI) 1.4 to 165.6 at 24 h; OR 2.8, CI 0.9 to 9.3 at 7 to 10 days; OR 4.2, CI 1.2 to 11.4 at 1 month. Thrombolysis reduced the prevalence of advanced wall motion abnormalities in the posterobasal segment at 24 h (55% vs. 75%, OR 0.5, CI 0.2 to 0.99), 7 to 10 days (44% vs. 73%, OR 0.3, CI 0.1 to 0.7) and 1 month (36% vs. 56%, OR 0.4, CI 0.2 to 0.9). Conclusions. There is a strong association between advanced wall motion abnormalities in the posterobasal segment and significant mitral regurgitation. In this study group, thrombolysis reduced the prevalence of advanced wall motion abnormalities in the posterobasal segment and thereby reduced the incidence of significant mitral regurgitation.
UR - http://www.scopus.com/inward/record.url?scp=0029070498&partnerID=8YFLogxK
U2 - 10.1016/0735-1097(95)00041-2
DO - 10.1016/0735-1097(95)00041-2
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
AN - SCOPUS:0029070498
SN - 0735-1097
VL - 25
SP - 1558
EP - 1563
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 7
ER -