Ischemic Mitral Regurgitation After Acute Myocardial Infarction in the Percutaneous Coronary Intervention Era.

Ischemic mitral regurgitation (IMR) is a term used to denote MR (mitral regurgitation) that occurs secondary to ischemic heart disease. Although transient ischemia can provoke IMR that is reversible with relief of ischemia, the most common form of IMR in clinical practice is associated with chronic ischemic cardiomyopathy. In such patients, global or regional left ventricular (LV) remodeling leads to a combination of leaflet tethering, reduced LV closing force, and annular dilation. LV dyssynchrony may also play a role when there is left bundle branch block. It has been demonstrated in multiple studies that IMR is associated with a poor prognosis in ischemic cardiomyopathy. Importantly, the initiating event that leads to ischemic cardiomyopathy is usually a first myocardial infarction (MI). Lamas et al reported that IMR in the setting of acute MI was associated with adverse prognosis SAVE trial (Survival And Ventricular Enlargement). Subsequently, Grigioni et al reported the effect of IMR on prognosis in the late phase post MI. However, those trials were performed before the routine use of acute percutaneous coronary intervention (PCI) as treatment of acute MI.