Comparison of Frequency of Mitral Regurgitation in Anterior Vs Inferior Wall Myocardial Infarction
DOI:
https://doi.org/10.54112/bcsrj.v6i5.2026Keywords:
Mitral regurgitation, anterior wall myocardial infarction, inferior wall myocardial infarction, echocardiographyAbstract
Mitral regurgitation (MR) is a common mechanical complication of acute myocardial infarction (MI) that significantly impacts morbidity and mortality. Objective: To determine and compare the frequency of mitral regurgitation in patients with anterior versus inferior wall myocardial infarction and to assess its association with echocardiographic and clinical parameters. Methodology: This Descriptive Cross-sectional study was conducted at the Cardiology Department of Ch. Pervaiz Elahi Institute of Cardiology, Wazirabad, from 10 October 2024 to 10 April 2025. A total of 75 patients with acute ST-elevation myocardial infarction were enrolled using non-probability consecutive sampling. Among them, 36 had anterior wall MI and 36 had inferior wall MI. All participants underwent electrocardiography and echocardiography upon admission, followed by a repeat echocardiogram after 72 hours to assess the presence and severity of MR. Baseline parameters such as age, gender, blood pressure, HbA1c, serum creatinine, Pro-BNP levels, and ejection fraction were recorded. Results: The mean age of the study population was 58.6 ± 10.4 years, with 64% males and 36% females. Mitral regurgitation was observed in 27 patients (36%), including 18 cases of mild, 7 of moderate, and 2 of severe MR. MR was significantly more frequent in inferior wall MI (61.1%) than in anterior wall MI (13.9%) (p = 0.001). The mean ejection fraction was lower in anterior wall MI (43.1 ± 7.8%) compared to inferior wall MI (49.5 ± 9.1%) (p = 0.02). MR was more common in patients with right coronary artery involvement, severe vessel occlusion (>75%), elevated Pro-BNP levels, and reduced ejection fraction (<45%) (p < 0.05). Conclusion: It is concluded that mitral regurgitation occurs significantly more frequently in inferior wall myocardial infarction compared to anterior wall infarction, mainly due to ischemic involvement of the posteromedial papillary muscle supplied by the right coronary artery. Early echocardiographic detection and management of MR in inferior wall MI patients are essential to prevent hemodynamic deterioration and improve overall clinical outcomes.
Downloads
References
Lindahl B, Mills NL. A new clinical classification of acute myocardial infarction. Nat Med. 2023 Sep;29(9):2200–5. https://doi.org/10.1038/s41591-023-02513-2
O’Lone E, Apple FS, Burton JO, Caskey FJ, Craig JC, deFilippi CR, et al. Defining myocardial infarction in trials of people receiving hemodialysis: consensus report from the SONG-HD MI Expert Working Group. Kidney Int. 2023 Jun 1;103(6):1028–37. https://doi.org/10.1016/j.kint.2023.02.033
Shah SN, Ahmad M, Raza VF, Riaz A, Wasif T, Younas N. Patterns of coronary artery vessel disease on diagnostic angiography in a South Asian population. Ann Pak Inst Med Sci. 2019;15(4):164–8. https://doi.org/10.48036/apims.v15i4.294
Chaudhari SS, Chokkaligam Mani B. Mitral Valve Insufficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan [updated 2023 May 1]. [No DOI available].
Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J. 2005 Aug;150(2):221–6. https://doi.org/10.1016/j.ahj.2004.09.025
Obayashi Y, Shiomi H, Morimoto T, Miyake M, Inoko M, Nishikawa R, et al. The impact of mitral regurgitation on long-term outcomes in acute myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol. 2023 Sep 15;203:384–93. https://doi.org/10.1016/j.amjcard.2023.07.038
Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg. 2003 Jan;125(1):135–43. https://doi.org/10.1016/S0022-5223(02)73243-6
Valuckienė Ž, Urbonaitė D, Jurkevičius R. Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: associated clinical factors and in-hospital outcomes. Medicina (Kaunas). 2015 Apr;51(2):92–9. https://doi.org/10.1016/j.medici.2015.02.003
Ullah I, Saeed I, Aamir M, Khan QA, Amin S, Khan N. Prevalence and severity of mitral regurgitation following acute myocardial infarction: impact of delayed revascularization and comorbidities. Pak Heart J. 2025;58(2):118–24. https://doi.org/10.47144/phj.v58i2.2864
Massimi G, Matteucci M, Kowalewski M, Ronco D, Chiarini G, De Piero ME, et al. Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction. Ann Cardiothorac Surg. 2022;11(3):328–36. https://doi.org/10.21037/acs-2022-ami-0016
Vandenbriele C, Balthazar T, Wilson J, Ledot S, Smith R, Caetano A, et al. Left heart Impella device to bridge acute mitral regurgitation to MitraClip procedure: a novel implementation of percutaneous mechanical circulatory support. Eur Heart J. 2020;41(Suppl 2):ehaa946-1849. https://doi.org/10.1093/ehjci/ehaa946.1849
Haberman D, Estévez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, et al. Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J. 2022;43(7):641–50. https://doi.org/10.1093/eurheartj/ehab496
Hakgör A. Percutaneous treatment of severe acute mitral regurgitation early after myocardial infarction and a short review of the literature. Turk Kardiyol Dern Ars. 2023;51(4):290–3. https://doi.org/10.5543/tkd.2022.09434
Estévez-Loureiro R, Tavares Da Silva M, Baz-Alonso JA, Caneiro-Queija B, Barreiro-Pérez M, Calvo-Iglesias F, et al. Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: a review. Front Cardiovasc Med. 2022;9:987122. https://doi.org/10.3389/fcvm.2022.987122
Turyan Medvedovsky A, Haberman D, Ibrahimli M, Tonchev I, Rashi Y, Peretz A, et al. Percutaneous mitral valve repair in patients with severe mitral regurgitation and acute decompensated heart failure. J Clin Med. 2021;10(24):5849. https://doi.org/10.3390/jcm10245849
Sharma H, Radhakrishnan A, Brown S, May J, Zia N, Joshi R, et al. Ischaemic mitral regurgitation: incidence, clinical and angiographic characteristics of 1000 patients with type 1 myocardial infarction undergoing percutaneous coronary intervention. Eur Heart J. 2020;41(Suppl 2):ehaa946-0070. https://doi.org/10.1093/ehjci/ehaa946.0070
Sharma H, Radhakrishnan A, Nightingale P, Brown S, May J, O’Connor K, et al. Mitral regurgitation following acute myocardial infarction treated by percutaneous coronary intervention—prevalence, risk factors, and predictors of outcome. Am J Cardiol. 2021;157:22–32. https://doi.org/10.1016/j.amjcard.2021.07.029
Huang H, Liu J, Bao K, Huang X, Huang D, Wei H, et al. Prevalence and mortality of moderate or severe mitral regurgitation among patients undergoing percutaneous coronary intervention with or without heart failure: results from CIN study with 28,358 patients. Front Cardiovasc Med. 2022;9:796447. https://doi.org/10.3389/fcvm.2022.796447
Ładziński S, Niedziela J, Witkowski A, Bartuś S, Lesiak M, Milewski K, et al. The influence of severe mitral regurgitation on major adverse cardiac and cerebrovascular events after myocardial infarction in 1-year follow-up: data from PL-ACS registry. Kardiol Pol. 2023;81(6):572–9. https://doi.org/10.33963/KP.a2023.0064
Wen X, Gao Y, Guo Y, Zhang Y, Yang M, Li Y, et al. Effect of mitral regurgitation on left ventricular deformation in myocardial infarction patients: evaluation by cardiac magnetic resonance imaging. J Magn Reson Imaging. 2022;56(3):790–800. https://doi.org/10.1002/jmri.28101
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Abdullah Mumtaz, Ali Bin Tariq, Aamir Siddique, Rao Shahzad Abdul Tawwab Khan, . Habiburahman, Abdul Sattar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
