Dynamic Changes and Prognostic Impact of Ischemic Mitral Regurgitation in Recurrent Myocardial Infarction

Abstract

BACKGROUND: The prognostic impact of ischemic mitral regurgitation (IMR) in recurrent myocardial infarction (MI) remains poorly defined. This study evaluated dynamic changes in IMR during recurrent MI and determined prognostic implications. METHODS AND RESULTS: We retrospectively reviewed 4,091 patients who underwent primary percutaneous coronary intervention for acute MI between May 2008 and July 2022. Of these patients, 88 experienced a second MI and underwent transthoracic echocardiography at 3 time points: before recurrent MI, at onset, and at discharge. IMR severity was assessed using mean vena contracta width. Logistic regression was used to determine predictors of persistent IMR, and Cox analysis was used to evaluate 5-year adverse outcomes (a composite of all-cause death, heart failure hospitalization, and third MI). IMR worsened at the onset of recurrent MI and remained elevated at discharge (P<0.001). Older age, lower left ventricular ejection fraction (LVEF), and greater IMR severity at onset independently predicted persistent IMR. In multivariable Cox analysis, residual IMR (per 1-mm increase: hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.08-1.38) and reduced LVEF (per 1% decrease: HR 0.95; 95% CI 0.92-0.98) were independently associated with a higher risk of 5-year adverse events. CONCLUSIONS: IMR changes dynamically during recurrent MI and often persists despite acute treatment. Residual IMR and reduced LVEF predicted long-term adverse outcomes, highlighting the importance of residual IMR assessment for risk stratification.

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BibTeX RIS

BibTeX

@article{nishino2026dynamic,
  title = {{Dynamic Changes and Prognostic Impact of Ischemic Mitral Regurgitation in Recurrent Myocardial Infarction}},
  author = {Chiharu Nishino and Shun Nishino and Akihiro Hayashida and Michinari Hieda and Shutaro Futami and Kensaku Nishihira and Keiichi Ashikaga and Nehiro Kuriyama and Yoshisato Shibata and Kenichi Tsujita},
  journal = {Circulation Journal},
  year = {2026},
  month = aug,
  doi = {10.1253/circj.cj-26-0430},
  url = {https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0430/_article},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Dynamic Changes and Prognostic Impact of Ischemic Mitral Regurgitation in Recurrent Myocardial Infarction
AU  - Chiharu Nishino
AU  - Shun Nishino
AU  - Akihiro Hayashida
AU  - Michinari Hieda
AU  - Shutaro Futami
AU  - Kensaku Nishihira
AU  - Keiichi Ashikaga
AU  - Nehiro Kuriyama
AU  - Yoshisato Shibata
AU  - Kenichi Tsujita
PY  - 2026
DA  - 2026/08/25
JO  - Circulation Journal
DO  - 10.1253/circj.cj-26-0430
UR  - https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-26-0430/_article
AB  - BACKGROUND: The prognostic impact of ischemic mitral regurgitation (IMR) in recurrent myocardial infarction (MI) remains poorly defined. This study evaluated dynamic changes in IMR during recurrent MI and determined prognostic implications. METHODS AND RESULTS: We retrospectively reviewed 4,091 patients who underwent primary percutaneous coronary intervention for acute MI between May 2008 and July 2022. Of these patients, 88 experienced a second MI and underwent transthoracic echocardiography at 3 time points: before recurrent MI, at onset, and at discharge. IMR severity was assessed using mean vena contracta width. Logistic regression was used to determine predictors of persistent IMR, and Cox analysis was used to evaluate 5-year adverse outcomes (a composite of all-cause death, heart failure hospitalization, and third MI). IMR worsened at the onset of recurrent MI and remained elevated at discharge (P<0.001). Older age, lower left ventricular ejection fraction (LVEF), and greater IMR severity at onset independently predicted persistent IMR. In multivariable Cox analysis, residual IMR (per 1-mm increase: hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.08-1.38) and reduced LVEF (per 1% decrease: HR 0.95; 95% CI 0.92-0.98) were independently associated with a higher risk of 5-year adverse events. CONCLUSIONS: IMR changes dynamically during recurrent MI and often persists despite acute treatment. Residual IMR and reduced LVEF predicted long-term adverse outcomes, highlighting the importance of residual IMR assessment for risk stratification.
SN  - 1347-4820
SN  - 1346-9843
ER  -

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