Circ Cardiovasc Imaging

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Circ Cardiovasc Imaging The Course of Ischemic Mitral Regurgitation in Acute Myocardial Infarction After Primary Percutaneous Coronary InterventionCLINICAL PERSPECTIVE by Shun Nishino, Nozomi Watanabe, Toshiyuki Kimura, Maurice Enriquez-Sarano, Tatsuya Nakama, Makoto Furugen, Hiroshi Koiwaya, Keiichi Ashikaga, Nehiro Kuriyama, and Yoshisato Shibata Circ Cardiovasc Imaging Volume 9(8):e004841 August 11, 2016 Copyright © American Heart Association, Inc. All rights reserved.

Course of ischemic mitral regurgitation (IMR) degree after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. Course of ischemic mitral regurgitation (IMR) degree after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. Changes in the degree of IMR early after PCI were studied in 467 patients, and it was possible to study the chronic changes in the IMR from the early post-PCI to the late post-PCI (6–8 mo after PCI) in 390 patients. Shun Nishino et al. Circ Cardiovasc Imaging. 2016;9:e004841 Copyright © American Heart Association, Inc. All rights reserved.

Serial color Doppler echocardiographic images of patients with acute myocardial infarction. Serial color Doppler echocardiographic images of patients with acute myocardial infarction. A, Ischemic mitral regurgitation (IMR) was significantly improved early and late after successful primary percutaneous coronary intervention (PCI) for the left circumflex artery lesion. Onset-to-reperfusion time was 240 min, and max creatine kinase–myocardial band (CK-MB) level was 94 U/L in this particular patient. B, IMR was significantly worsened early and late after successful primary PCI for the left anterior descending artery lesion. Onset-to-reperfusion time was 1440 min, and max CK-MB level was 397 U/L in this particular patient. Shun Nishino et al. Circ Cardiovasc Imaging. 2016;9:e004841 Copyright © American Heart Association, Inc. All rights reserved.

Changes in left ventricular (LV) parameters (end-diastolic volume [EDV], end-systolic volume [ESV], and LV ejection fraction [LVEF]) according to the changes of ischemic mitral regurgitation (IMR) after primary percutaneous coronary intervention (PCI) in acute phase and chronic phase. Changes in left ventricular (LV) parameters (end-diastolic volume [EDV], end-systolic volume [ESV], and LV ejection fraction [LVEF]) according to the changes of ischemic mitral regurgitation (IMR) after primary percutaneous coronary intervention (PCI) in acute phase and chronic phase. Changes in the magnitude of IMR were significantly related to the degree of LV improvement both in the acute phase (1–2 wk after primary PCI; A–C) and chronic phase (6–8 mo after primary PCI; D–F). Degree of improvement in EDV, ESV, and LVEF were incrementally larger in the IMR-improvement group compared with the IMR-no change group and the IMR-worsening group, both in the acute phase and chronic phase after PCI (P<0.01). Shun Nishino et al. Circ Cardiovasc Imaging. 2016;9:e004841 Copyright © American Heart Association, Inc. All rights reserved.

Event-free survival according to the degree of acute ischemic mitral regurgitation (IMR). Event-free survival according to the degree of acute ischemic mitral regurgitation (IMR). A, The existence of ≥moderate IMR before percutaneous coronary intervention (PCI) was associated with adverse 30-d prognosis after successful primary PCI for acute myocardial infarction. B, ≥mild IMR detected at emergency room significantly worsened the long-term prognosis after primary. MACE indicates major adverse cardiac events. Shun Nishino et al. Circ Cardiovasc Imaging. 2016;9:e004841 Copyright © American Heart Association, Inc. All rights reserved.

Event-free survival according to the presence of chronic ischemic mitral regurgitation (IMR). Event-free survival according to the presence of chronic ischemic mitral regurgitation (IMR). The existence of ≥mild IMR in the follow-up period after primary percutaneous coronary intervention was associated with decreased survival from cardiac events. MACE indicates major adverse cardiac events. Shun Nishino et al. Circ Cardiovasc Imaging. 2016;9:e004841 Copyright © American Heart Association, Inc. All rights reserved.