| ǥ :
|
ȣ - 520595 267 |
| Left ventricular remodeling and systolic dysfunction rather than papillary muscle displacement is associated with mitral regurgitation in the acute phase of inferior wall myocardial infarction |
| 연세대학교 심장혈관병원 심장내과 |
| 홍성진, 하종원, 심지영, 최의영, 김중선, 고영국, 최동훈, 장양수, 정남식 |
Background: Ventricular remodeling with papillary muscle displacement has been
known as an important mechanism of mitral regurgitation (MR) in the chronic phase of myocardial infarction (MI), especially in patients with inferior wall MI. However, in the acute phase of MI, the mechanism of MR is unclear. The purpose of this study was to compare geometric changes and left ventricular (LV) function between patients with or without MR after acute inferior MI.
Methods: In 83 patients (age 59±10 years, male 83%) with acute inferior wall MI, we evaluated the severity of MR, mitral deformation (tenting and annulus area), LV global remodeling (LV end-diastolic and end-systolic volume, sphericity), local remodeling (distances between papillary muscle tips and the contralateral mitral annulus), LV ejection fraction (EF) and regional wall motion score index (RWSI) within 10 days after MI. Results: MR was present in 28(34%); mild in 14(17%), and moderate to severe in 14(17%). There were no significant differences in mitral annular area, sphericity and distances between papillary muscle tips and the contralateral mitral annulus. However, patients with severe MR had significantly larger LV end-diastolic and end-systolic volume, and tenting area. There was a graded relationship between the severity of MR and LVEF and RWSI.
Conclusion: In the acute phase of inferior wall MI, MR was associated with LV
remodeling and systolic dysfunction rather with papillary muscle displacement. The presence of ischemic MR in patients with inferior MI may be a reflector of poor LV function and dilated LV.
|
|
Mitral regurgitation |
None
(n=55) |
Mild
(n=14) |
Moderate to severe
(n=14) |
|
|
Mitral Deformation
Tenting area/BSA (cm2/m2) |
0.58 ± 0.25 |
0.74 ± 0.32 |
0.77 ± 0.36 |
0.040 |
|
LV global and local function
LV ejection fraction (%)
Total RWMSI
Inferior RWMSI |
51.8 ± 8.9
1.63 ± 0.51
2.13 ± 0.84 |
43.9 ± 12.8
2.06 ± 1.00
2.41 ± 1.03 |
35.7 ± 11.5
2.25 ± 0.69
2.86 ± 1.07 |
<0.001
0.002
0.031 |
|
LV global and local remodeling
Sphericity
LVEDVI (ml/m2)
LVESVI (ml/m2)
Annular to APM/BSA (mm/m2)
Annular to PPM/BSA (mm/m2) |
2.24 ± 0.47
62.1 ± 20.2
28.8 ± 10.7
26.5 ± 5.8
25.4 ± 5.8 |
2.18 ± 0.54
65.0 ± 25.5
32.3 ± 20.2
28.2 ± 10.7
24.6 ± 8.4 |
2.34 ± 0.70
81.1 ± 35.0
50.3 ± 28.0
27.1 ± 9.5
25.4 ± 8.8 |
0.740
0.052
0.001
0.777
0.930 | BSA = body surface area, APM = anterior papillary muscle, PPM = posterior papillary muscle
|
|
|
