0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Mitral Regurgitation in Early Myocardial Infarction: Incidence, Clinical Detection, and Prognostic Implications

Kenneth G. Lehmann, MD; Charles K. Francis, MD; Harold T. Dodge, MD, TIMI Study Group*
[+] Article and Author Information

Grant Support: By the National Heart, Lung, and Blood Institute.

Requests for Reprints: Kenneth G. Lehmann, MD, DVA Medical Center (111C), 1660 South Columbian Way, Seattle, WA 98108.

Current Author Addresses: Dr. Lehmann: DVA Medical Center (111C), 1660 South Columbian Way, Seattle, WA 98108.

Dr. Francis: Harlem Hospital (KP 14101), 506 Lenox Avenue, New York, NY, 10037.

Dr. Dodge: University Hospital (RG-22), Seattle, WA 98195.


From Yale University School of Medicine, New Haven, Connecticut; and University of Washington School of Medicine, Seattle, Washington. For current author addresses, see end of text.*For members of the Thrombolysis in Myocardial Infarction (TIMI) Study Group, see the Appendix.


© 1992 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1992;117(1):10-17. doi:10.7326/0003-4819-117-1-10
Text Size: A A A

Objective: To investigate mitral regurgitation occurring early in the course of acute myocardial infarction with respect to its incidence, the impact of infarct size and location, the accuracy of clinical detection, the contribution of global and regional left ventricular performance, and its influence on prognosis.

Design: Prospective observational study derived from patients entering Phase I of the Thrombolysis in Myocardial Infarction (TIMI) trial.

Setting: Multicenter trial involving 13 universityaffiliated medical centers.

Patients: A total of 206 patients studied within 7 hours of symptom onset during their first myocardial infarction.

Measurements: Contrast left ventriculography was used to document mitral regurgitation.

Results: Mitral regurgitation was present in 27 patients (13%). Although the presence of regurgitation correlated with the site of infarction (20 of 27 had anterior infarctions) and the number of akinetic chords, it was not statistically related to the peak creatine kinase value or to left ventricular chamber size or filling pressure. A murmur of mitral regurgitation was heard in only 2 patients (1 incorrectly). The presence of early mitral regurgitation predicted cardiovascular mortality at 1 year by univariate (relative risk, 12.2; 95% Cl, 3.5 to 42; P < 0.0001) and multivariate (relative risk, 7.5; Cl, 2.0 to 28.6; P = 0.0008) analyses.

Conclusions: Mitral regurgitation in early myocardial infarction is generally clinically "silent," is more common in anterior infarction, is associated with regional dysfunction but not early ventricular dilation or peak enzyme release, and is an important predictor of cardiovascular mortality.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)