Mitral Regurgitation Severity with Left Atrial Volume Index as a Guide to the Early Myocardial Infarction Prognostic Outcome

Background: Mitral regurgitation and the increase in left atrial volume are seen frequently in severe acute myocardial infarction. They are associated with left ventricular dysfunction and may predict the prognosis and the outcome for long term follow up myocardial infarction. It is important to understand the effect of both in early admission to intensive care unit especially on the development of shock, heart failure, dysrhythmia and the mortality.

Methods: This is a prospective study carried out at Al Sader Teaching Hospital in Najaf City and in Cardiac Care Unit (CCU) from March 2014 to November 2014. 150 Patients with acute myocardial infarction were followed during their admission in CCU. Recording was done to the variables like age, sex, STEMI (ST Elevation Myocardial Infarction) or NSTEMI (Non ST Elevation Myocardial Infarction) types, the site of infarction, presence or absence of shock, pulmonary edema and dysrhythmia. All patients were studied by Echo-Doppler and mitral regurgitation severity was recorded as well as measurement of the left atrial volume index and both were correlated with the variables.

Results: Mean age 66±15, 52.52% females, NSTEMI 65%, 30% atrial arrhythmia, 32% ventricular arrhythmia, left atrial volume index increased in 59%, mitral regurgitation in 56%. Severity grading of mitral regurgitation and the increase in left atrial volume index were significantly associated with shock p value 0.001, pulmonary edema p value 0.001 and arrhythmia P value 0.001. The mortality in acute myocardial infarction patients found to be significantly associated with the increase in Left Atrial Volume Index p value 0.0001 and with the severity of Mitral Regurgitation p value 0.013.

Mortality of acute myocardial infarction was also significantly associated with pulmonary edema 0.001, shock p value 0.03 and site of infarction p value 0.017as well as the type of the infarction p value 0.007.

Conclusion: Both mitral regurgitation severity and left atrial volume can predict the early outcome of Myocardial Infarction in early Cardiac Care Unit admission.