Heart failure and death after myocardial infarction in the community - The emerging role of mitral regurgitation
Heart failure and death after myocardial infarction in the community - The emerging role of mitral regurgitation
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DOI：
10.1161/01.cir.0000151097.30779.04
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发表时间：
2005-01-25
期刊：
影响因子：
37.8
通讯作者：
Roger, VL
中科院分区：
文献类型：
--
作者：
Bursi, F;Enriquez-Sarano, M;Roger, VL
背景-在病例系列中，二尖瓣返流(MR)增加了心肌梗死(MI)后死亡的风险，但MR的患病率、其相对于射血分数(EF)的增量预后价值及其与社区MI后心力衰竭和死亡的关系尚不清楚。方法和结果-在1988年至1998年期间，在一个地理定义的MI发病队列中，对1331名患者的MR患病率及其与心力衰竭和死亡的相关性进行了研究。773名患者(58%)在心肌梗死后30天内进行了超声心动图检查，其中50%的患者出现MR，38%的患者出现轻度MR，12%的患者出现中度或重度MR。在MR患者中，临床上不一致地检测到杂音。经过4.7+/-3.3年的随访，发生了109次心力衰竭和335例死亡。MR的存在和严重程度与心力衰竭或死亡之间存在分级正相关。在存活30天的患者中，无论年龄、性别、EF和Killip分级，中度或重度MR与心力衰竭风险(相对风险3.44，95%可信区间1.74~6.82，P<；0.001)和死亡风险(相对风险1.55，95%可信区间1.08~2.22，P=0.019)显著相关。它提供了独立于年龄、性别、EF和Killip分级的信息来预测30天幸存者中的心力衰竭或死亡。这些发现适用于以社区为基础的大规模心肌梗死队列，建议应将MR的评估包括在心肌梗死后风险分层中。
Background - In case series, mitral regurgitation (MR) increased the risk of death after myocardial infarction (MI), yet the prevalence of MR, its incremental prognostic value over ejection fraction (EF), and its association with heart failure and death after MI in the community is not known.Methods and Results - The prevalence of MR and its association with heart failure and death were examined among 1331 patients within a geographically defined MI incidence cohort between 1988 and 1998. Echocardiography was performed within 30 days after MI in 773 patients (58%), and MR was present in 50% of cases, mild in 38%, and moderate or severe in 12%. Among patients with MR, a murmur was inconsistently detected clinically. After 4.7 +/- 3.3 years of follow-up, 109 episodes of heart failure and 335 deaths occurred. There was a graded positive association between the presence and severity of MR and heart failure or death. Moderate or severe MR was associated with a large increase in the risk of heart failure ( relative risk 3.44, 95% CI 1.74 to 6.82, P < 0.001) and death ( relative risk 1.55, 95% CI 1.08 to 2.22, P = 0.019) among 30-day survivors independent of age, gender, EF, and Killip class.Conclusions - In the community, MR is frequent and often silent after MI. It carries information to predict heart failure or death among 30-day survivors independently of age, gender, EF, and Killip class. These findings, which are applicable to a large community-based MI cohort, suggest that the assessment of MR should be included in post-MI risk stratification.