This prospective study consisted of 45 patients who presented with STEMI and at least mild IMR, revascularized with successful PCI of the infarct related artery within 1 hour from the onset of chest pain on admission. Patients’ age was 52,7 ± 17,4 years, with male dominancy (91 %). Thirteen (29 %) patients had hypertension, 7 (16 %) had type II diabetes and 23 (51 %) were current smokers. Medical treatment was standard for statins and antiplatelets, 5 (11 %) patients were receiving angiotensin converting enzyme inhibitors, 18 (40 %) angiotensin receptor blockers, 16 (36 %) beta blockers and 6 (13 %) diuretics. The localization of myocardial involvement during infarction were; 23 (51,1 %) anterior, 17 (37,8 %) inferior, 3 (6,7 %) infero-posterior, 2 (4,4 %) infero-lateral walls, 15 (33,3 %) patients had Rentrop grade >2 collaterals. Infart related artery was left anterior descending artery in 23 (51,1 %) patients, right coronary artery in 20 (44,4 %), and circumflex artery in 2 (4,4 %).
26 of 45 patients (58 %) who described stable angina pectoris were included in the angina (+), and 19 patients (42 %) declared that they did not have angina were included in the angina (-) group.
There were no statistical diferences between the two groups in terms of age, gender, BMI, comorbidities, hemodynamic parameters at hospital admission and localization of MI.
Evolution of ischemic mitral regurgitation within 3 months in angina (+) and (-) patients
None of the patients met the criteria for severe MR (EROA 0.2 cm2, Rvol 30 ml) [23] throughout the follow-up period. Echocardiographic measurements and calculations of PISA-r, EROA and Rvol were of similar values, with statistically insignificant differences between the angina (+) and angina (-) groups at the 1st day (PISA-r : 0,19 ± 0.14 cm versus 0,13 ± 0.14 cm, p = 0.178; EROA : 0,08 ± 0.07 cm2 versus 0,06 ± 0,07 cm2, p = 0.247; Rvol : 8,50 ± 9,54 ml, versus 6,37 ± 8,87 ml, p = 0.284 respectively) and 3rd day (PISA-r : 0,19 ± 0,15 cm versus 0,17 ± 0,15 cm, p = 0.666, EROA : 0,08 ± 0,09 cm2 versus 0,08 ± 0,08 cm2 , p = 0.816, Rvol : 8,27 ± 10,76 ml versus 9,11 ± 11,20 ml, p = 0.852 respectively) of STEMI. At the end of the 3rd month compared to 1st day PISA-r (0,19 ± 0,14 cm versus 0,07 ± 0,08 cm; p < 0,001), EROA (0,08 ± 0,07 cm2 versus 0,02 ± 0,03 cm2; p < 0,001) and Rvol (8,50 ± 9,54 ml vs. 2,35 ± 4,11 ml; p < 0,001) were significantly decreased in the angina (+) group. Whereas in the angina (-) group; PISA-r and EROA were slightly and insignificantly increased at 3rd month compared to 1st day, only Rvol was increased significantly (6.37 ± 8.87 ml versus 11.95 ± 11.85 ml, p=0.03). When angina (+) and (-) patients were compared at 3rd month, PISA-r (0,07 ± 0,08 cm versus 0,23 ± 0,23 cm, p = 0.012), EROA (0,02 ± 0,03 cm2 versus 0,10 ± 0,09 cm2, p = 0.007) and Rvol (2,35 ± 4,11 ml versus 11,95 ± 11,85 ml, p = 0.011), were significantly higher in angina (-) patients. The evolution of PISA-r, EROA and Rvol from the first day through the 3rd month had a tendency to decrease in angina (+) patients ( decrease PISA-r : 0.12 ± 0.11 cm, EROA : 0.06 ± 0.06 cm2, Rvol : 6.15 ± 7.35 ml) and increase in angina (-) patients ( increase PISA-r : 0.09 ± 0.021 cm, EROA : 0.04 ± 0.08 cm2, Rvol : 5.58 ± 10.48 ml), and p < 0.001 for each. (Figure 2, Table 2, 3)
Change in left ventricular ejection fraction (EF %) within 3 months
Ejection fraction at 1st (55,3 ± 8,3 % versus 48,9 ± 9,1 %, p=0.024) and 3rd day (56,1 ± 9,4 % vs. 49,5 ± 9,5 %, p=0.009) of the study were significantly higher in angina (-) group of patients. Throughout the 3rd month, EF of angina (-) group was preserved with a slight decrease (-1,8 ± 6,3 %), whereas a significant increase (+7,4 ± 5,5 %, p < 0,001) in angina (+) group was detected. Despite all these changes in EF, at the end of the 3rd month, angina (+) and angina (-) groups had similar (56,2 ± 7,0 % versus 53,5 ± 8,6 %, p = 0,461) values of EF %. (Figure 2, Table 2, 3)
Biochemical markers within 3 months
In both angina (+) and angina (-) groups, 1st day and 3rd month of haemoglobin and creatinine were within normal range and statistically insignificant (haemoglobin 1st day : p = 0,8; 3rd month : p = 0,4; creatinine 1st day p = 0,08; 3rd month p = 0,7). Hs-TnT was insignificantly increased on 1st day as expected in both groups (p = 0,9), and within normal range at 3rd month (p = 0.8). CK-MB levels at 1st day was not statistically significant between the groups (p = 0.918), however CK-MB levels at 3rd month were found to be significantly lower in the angina (+) group compared to the angina (-) although within normal range (p=0.034). NT-proBNP values were found to be increased in both groups with statistically insignificant (p = 0.352) levels at 1st day, decreased at 3rd month nevertless still slightly high and statistically insignificant (p = 0.662) (Table 4).