Journal of the American College of Cardiology
Improved posterobasal segment function after thrombolysis is associated with decreased incidence of significant mitral regurgitation in a first inferior myocardial infarction
Author + information
- Alexander Tenenbaum, MD*,1,
- Jonathan Leor, MD1,
- Michael Motro, MD, FACC1,
- Hanoch Hod, MD, FACC1,
- Elieser Kaplinsky, MD, FACC1,
- Babeth Rabinowitz, MD, FACC1,
- Valentina Boyko, MSc1 and
- Zvi Vered, MD, FACC1
- ↵*Address for correspondence:Dr. Alexander Tenenbaum, The Heart Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Abstract
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 wall 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.
Footnotes
↵1 From the Heart Institute. Sheba Medical Center. Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
This work was supported in part by Grant 768/92 to Dr. Vered from the Science Foundation, National Academy of Sciences and Humanities, Jerusalem, Israel.
- Received October 20, 1994.
- Revision received January 11, 1995.
- Accepted January 19, 1995.
- American College of Cardiology
