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Long-term prognostic value of mitral regurgitation in acute coronary syndromes.

Journal article
Authors Anita Persson
Marianne Hartford
Johan Herlitz
Thomas Karlsson
Torbjörn Omland
Kenneth Caidahl
Published in Heart (British Cardiac Society)
Volume 96
Issue 22
Pages 1803-8
ISSN 1468-201X
Publication year 2010
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1803-8
Language en
Links dx.doi.org/10.1136/hrt.2010.203059
Subject categories Clinical physiology, Cardiac and Cardiovascular Systems

Abstract

OBJECTIVES: To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS). DESIGN: Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA. SETTING: Single-centre university hospital. PATIENTS: 725 patients with ACS. MAIN OUTCOME MEASURES: Death and readmission for congestive heart failure. RESULTS: During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003). CONCLUSIONS: MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.

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