Background: Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR. However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI. Methods and results:Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the first 7 days after a first ST elevation myocardial infarction (STEMI), and after 4 years of follow-up. The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33 cm, p<0.05), independently of the presence or severity of IMR. The posterior leaflet length and area got smaller over time (1.53±0.51 cm vs 1.27±0.33 cm; p<0.05 and 5.65±1.58 cm2 vs 4.88±1.65 cm2; p<0.05, respectively). The tenting height and area were smaller at follow-up (9.06±2.6 mm vs 7.84±2.61 mm, p<0.05; and 1.88±0.6 cm2 vs 1.57±0.5 cm2; p<0.05, respectively). A larger tenting at follow-up correlated with 3D left atrial (LA) volumes, but not with LV volumes and ejection fraction. Conclusions: MV geometry changes over time even in patients with non-severe IMR. The MV healing process consists in annulus flattening associated with improved tenting.

Echocardiography is the first cardiac imaging technique used to evaluate patients presenting with acute coronary syndrome (ACS). However, in the absence of wall motion abnormalities, conventional echocardiography at rest provides little information. Patients presenting with low risk ACS usually have normal wall motion and left ventricle ejection fraction (LVEF) at rest.

In the past two decades, the association between the cardiovascular autonomic dysfunction and the cardiovascular mortality has been well documented. This association indicates that individuals with abnormal autonomic function tests are candidates for close surveillance. In type 2 diabetes it is recommended that a baseline determination of cardiovascular autonomic function be performed upon diagnosis and within 5 years of diagnosis for those with type 1 diabetes, followed by a yearly repeat test.[1]
Out of the markers that objectify this relationship, heart rate variability (HRV) has proven to be the most reliable and the easiest to quantify. Although HRV has been the subject of numerous clinical studies whose purpose was linking heart rate changes to the gravity and the evolution of the disease, only in two clinical settings a consensus was reached. The drop in HRV can be used as a risk factor in the period following an acute myocardial infarction (AMI) and as a warning sign for cardiac autonomic neuropathy (CAN) in diabetic patients. HRV parameters and their possible prognostic significance have not been thoroughly evaluated in patients presenting pulmonary arterial hypertension.