n =
Inclusion
Mean age (years)
Quantitation of MR
Recruitement
Timing of echo/MI
MR (%)
Moderate/Severe MR (%)
Van Dantzig et al. [20]
188
Acute MI
63
Jet area
Hospitalised pts
<48 h
–
13 moderate or severe
Ma et al. [15]
223
Acute MI
59
Jet area
Hospitalised pts
Admission
21
–
1–3 months
39
Neskovic et al. [16]
131
Acute MI
55
Jet area
Hospitalised pts
1 week
26
–
1 year
38
18 grade ≥ 2/3
Feinberg et al. [21]
417
Acute MI
62
Jet area
Hospitalised pts
<48 h
35
6 moderate or severe
Golia et al. [22]
191
Recent MI (mean 17 days)
60
Jet area
Patients referred for dobutamine echo
Mean 17 days
59
8 grade ≥ 3/4
Bursi et al. [7]
773
Recent MI
69
Jet area
Cohort
Mean 3 days
50
12 moderate or severe
<30 days
Aronson et al. [23]
1,190
Acute MI
61
Jet area
Hospitalised pts
Median 2 days
46
6 moderate or severe
Perez de Isla et al. [24]
279
NSTEMI (<1 week)
66
Semi-quantitative
Hospitalised pts
Median 2 days
40
16 grade ≥ 3/4
Okura et al. [25]
524
Chronic IHD (12 % MI <14 days)
69
Jet area
Referred for echo
–
–
11 severe
Table 1.2
Prevalence of secondary mitral regurgitation in chronic heart failure with left ventricular dysfunction
n= | Mean age (years) | Mean LVEF (%) | Quantitation of MR | Recruitement | Ischaemic heart disease (%) | MR (%) | MR severity (%) | |
|---|---|---|---|---|---|---|---|---|
Varadarajan et al. [8] | 370 | 65 | 21 | Jet area + quantitative Doppler | Heart failure clinic | 39 | 94* | 15 grade 3/4 |
14 grade 4/4 | ||||||||
Rossi et al. [26] | 1,256 | 67 | 32 | Quantitative Doppler | Hospitalised pts in 4 centres | 61 | 73 | 24 with ERO ≥0.20 cm2 or reg. vol >30 ml |
Agricola et al. [28] | 198 | 66 | 33 | Quantitative Doppler | Hospital cohort | 0 | 65 | 50 with ERO ≥0.20 cm2 |
Bursi et al. [29] | 469 | 60 | 30 | Jet area | Outpatient clinic in 2 centres | 36 | 95 | 30 grade 3/4 |
14 grade 4/4 | ||||||||
Deja et al. [14] | 1,212 | 60 | 27 | Site-reported | Randomized trial (99 centres) | 100 | 64 | 18 moderate or severe |
Indication for CABG + EF < 35 % |
The only population-based study was performed in a prospective cohort of 1,331 patients who experienced a first myocardial infarction [7]. Echocardiographic examination was performed a mean of 3.0 ± 4.5 days following myocardial infarction in 773 patients (58 %). Ischaemic MR was present in 386 patients (50 %) and graded mild in 297 (38 %) and moderate or severe in 89 (12 %). Patients who did not undergo echocardiography were younger, had a lower Killip class and a smaller infarction size. Patients with MR were older, more frequently women, had more frequent comorbidities, more severe impairment of left ventricular function, higher pulmonary pressures and a greater Killip class than patients without MR. Conversely, there was no relationship between the presence of ischaemic MR and the extent and location of myocardial infarction (anterior or inferior). The frequency of ischaemic MR did not significantly differ between ST elevation and non-ST elevation myocardial infarction (46 % vs. 52 % respectively, p = 0.10).
An estimation based on a literature search and extrapolation to the US adult population concluded that restrictive MR (Carpentier type III) was the most frequent mechanism of MR and estimated a prevalence of moderate-to-severe ischaemic MR between 7.5 and 9 per 1,000 [27].
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