IMPROVED POSTEROBASAL SEGMENT FUNCTION AFTER THROMBOLYSIS IS ASSOCIATED WITH DECREASED INCIDENCE OF SIGNIFICANT MITRAL REGURGITATION IN A FIRST INFERIOR MYOCARDIAL-INFARCTION

被引：37

作者：

TENENBAUM, A ^{[1
]}

LEOR, J ^{[1
]}

MOTRO, M ^{[1
]}

HOD, H ^{[1
]}

KAPLINSKY, E ^{[1
]}

RABINOWITZ, B ^{[1
]}

BOYKO, V ^{[1
]}

VERED, Z ^{[1
]}

机构：

[1] TEL AVIV UNIV, SACKLER FAC MED, IL-69978 TEL AVIV, ISRAEL

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 1995年 / 25卷 / 07期

关键词：

D O I：

10.1016/0735-1097(95)00041-2

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives. This study was designed to investigate the association between wall motion abnormalities and the occurrence of ischemic mitral regurgitation in patients with a first inferior or posterior myocardial infarction and to reassess the role of thrombolytic treatment in these patients. Background. We previously demonstrated that thrombolytic therapy reduces the incidence of significant mitral regurgitation in patients with a first inferior myocardial infarction, but the mechanisms responsible for this decrease were not clear. Methods. Wall motion score on two-dimensional echocardiography (16 segments) and mitral regurgitation grade (0 to 3) on Doppler color flow imaging were assessed in 95 patients (in 47 after thrombolysis) at 24 h, 7 to 10 days and 1 month after myocardial infarction. Significant mitral regurgitation was defined as moderate or severe (grade 2 or 3). Results. Multivariate analysis revealed that the presence of an advanced wall motion abnormality of the posterobasal segment of the left ventricle was the most significant independent variable associated with significant mitral regurgitation: odds ratio (OR) 15.0, 90% confidence interval (CI) 1.4 to 165.6 at 24 h; OR 2.8, CI 0.9 to 9.3 at 7 to 10 days; OR 4.2, CI 1.2 to 11.4 at 1 month. Thrombolysis reduced the prevalence of advanced well motion abnormalities in the posterobasal segment at 24 h (55% vs. 75%, OR 0.5, CI 0.2 to 0.99), 7 to 10 days (44% vs. 73%, OR 0.3, CI 0.1 to 0.7) and 1 month (36% vs. 56%, OR 0.4, CI 0.2 to 0.9). Conclusions. There is a strong association between advanced wall motion abnormalities in the posterobasal segment and significant mitral regurgitation. In this study group, thrombolysis reduced the prevalence of advanced wall motion abnormalities in the posterobasal segment and thereby reduced the incidence of significant mitral regurgitation.

引用

页码：1558 / 1563

页数：6

共 36 条

[1]

Rankin, Hickey, Smith, Et al., Ischemic mitral regurgitation, Circulation, 79, pp. 116-121, (1989)

[2]

De Busk, Harrison, The clinical spectrum of papillary muscle disease, N Engl J Med, 281, pp. 1458-1467, (1969)

[3]

Barzilai, Davis, Stone, Jaffe, Prognostic significance of mitral regurgitation in acute myocardial infarction, Am J Cardiol, 65, pp. 1169-1175, (1990)

[4]

Heikkila, Mitral incompetence complicating acute myocardial infarction, Br Heart J, 29, pp. 162-169, (1967)

[5]

Izumi, Miyatake, Beppu, Et al., Mechanism of mitral regurgitation in patients with myocardial infarction: a study using real-time two-dimensional Doppler flow imaging and echocardiography, Circulation, 76, pp. 777-785, (1987)

[6]

Hickey, Smith, Muhlbaier, Et al., Current prognosis of ischemic mitral regurgitation: implications for future management, Circulation, 78, pp. 51-59, (1988)

[7]

Lehmann, Francis, Dodge, Mitral regurgitation in early myocardial infarction Incidence clinical detection and prognostic implications, Annals of Internal Medicine, pp. 10-17, (1992)

[8]

Braunwald, Valvular heart disease, Heart Disease: A text book of Cardiovascular Medicine, pp. 1018-1035, (1992)

[9]

Leor, Feinberg, Vered, Et al., Effect of thrombolytic therapy on the evolution of significant mitral regurgitation in patients with a first inferior myocardial infarction, J Am Coll Cardiol, 21, pp. 1661-1666, (1993)

[10]

Loperfido, Biasucci, Pennestri, Et al., Pulsed Dopple echocardiographic analysis of mitral regurgitation after myocardial infarction, Am J Cardiol, 58, pp. 692-697, (1986)

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