Pathogenesis of mitral regurgitation in acute myocardial infarction: Importance of changes in left ventricular shape and regional function

The pathogenesis of mitral regurgitation (MR) was determined by quantitative echocardiography in 188 patients with acute myocardial infarction (AMI) within 48 hours after admission. MR was classified, by using color Doppler, as significant (grades 3 to 4) or trivial (grades 0 to 2). Left ventricular (LV) function (global and regional), volume, and shape, as well as mitral valvular features, were measured and analyzed by stepwise logistic regression. Significant MR occurred in 25 (13%) patients. Univariately, recurrent infarction (p < 0.01), LV dilatation (p < 0.001) and sphericity (p < 0.001), inferoposterolateral asynergy (p < 0.001), mitral annular dilatation (p < 0.005), and mitral leaflet restriction (p < 0.05) were associated with significant MR. In regression analysis, only recurrent infarction (odds ratio 5.08), LV sphericity index (odds ratio 1.12), and inferoposterolateral asynergy (odds ratio 6.07) were independently associated with significant MR, whereas none of the mitral valvular features examined had an independent association. In conclusion, changes in LV shape and regional function and not mitral valvular changes are prime determinants of significant MR after AMI.