TY - JOUR
T1 - Prognostic Impact of Extra–Mitral Valve Cardiac Involvement in Patients With Primary Mitral Regurgitation
AU - van Wijngaarden, Aniek L.
AU - Mantegazza, Valentina
AU - Hiemstra, Yasmine L.
AU - Volpato, Valentina
AU - van der Bijl, Pieter
AU - Pepi, Mauro
AU - Palmen, Meindert
AU - Delgado, Victoria
AU - Ajmone Marsan, Nina
AU - Tamborini, Gloria
AU - Bax, Jeroen J.
N1 - Funding Information: The Department of Cardiology of Leiden University Medical Center has received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr Delgado has received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr Marsan has received speaker fees from GE Healthcare and Abbott Vascular. Dr Bax has received speaker fees from Abbott Vascular. Dr Volpato has received speaker fees from Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 American College of Cardiology Foundation
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: In patients with severe primary mitral regurgitation (MR), the indication for surgery is currently based on the presence of symptoms, left ventricular dilatation and dysfunction, atrial fibrillation, and pulmonary hypertension. Objectives: The aim of this study was to evaluate the prognostic impact of the presence of extra–mitral valve cardiac involvement (including known risk factors but also severe left atrial [LA] dilatation and right ventricular [RV] dysfunction) in a large multicenter study of patients with primary MR. Methods: Patients with severe primary MR undergoing surgery were included and categorized according to the extent (highest) of cardiac involvement: group 0, no cardiac involvement; group 1, left ventricular involvement; group 2, LA involvement; group 3, pulmonary vasculature or tricuspid valve involvement; or group 4, RV involvement. The outcome was all-cause mortality. Results: A total of 1,106 patients were included (mean age 63 ± 12 years, 68% male). In total, 377 patients (34%) were classified in group 0, 239 (22%) in group 1, 213 (19%) in group 2, 180 (16%) in group 3, and 97 (9%) in group 4. Kaplan-Meier curve analysis revealed significantly worse survival (log-rank chi-square = 43.4; P < 0.001) with higher group. On multivariable analysis, age, male sex, chronic obstructive pulmonary disease, kidney function, and group of cardiac involvement were independently associated with all-cause mortality. For each increase in group, a 17% higher risk for all-cause mortality was observed (95% CI: 1.051-1.313; P = 0.005) during a median follow-up time of 88 months. Conclusions: In patients with severe primary MR, a novel classification system based on extra–mitral valve cardiac involvement may help refine risk stratification and timing of surgery, particularly including severe LA dilatation and RV dysfunction in the assessment.
AB - Background: In patients with severe primary mitral regurgitation (MR), the indication for surgery is currently based on the presence of symptoms, left ventricular dilatation and dysfunction, atrial fibrillation, and pulmonary hypertension. Objectives: The aim of this study was to evaluate the prognostic impact of the presence of extra–mitral valve cardiac involvement (including known risk factors but also severe left atrial [LA] dilatation and right ventricular [RV] dysfunction) in a large multicenter study of patients with primary MR. Methods: Patients with severe primary MR undergoing surgery were included and categorized according to the extent (highest) of cardiac involvement: group 0, no cardiac involvement; group 1, left ventricular involvement; group 2, LA involvement; group 3, pulmonary vasculature or tricuspid valve involvement; or group 4, RV involvement. The outcome was all-cause mortality. Results: A total of 1,106 patients were included (mean age 63 ± 12 years, 68% male). In total, 377 patients (34%) were classified in group 0, 239 (22%) in group 1, 213 (19%) in group 2, 180 (16%) in group 3, and 97 (9%) in group 4. Kaplan-Meier curve analysis revealed significantly worse survival (log-rank chi-square = 43.4; P < 0.001) with higher group. On multivariable analysis, age, male sex, chronic obstructive pulmonary disease, kidney function, and group of cardiac involvement were independently associated with all-cause mortality. For each increase in group, a 17% higher risk for all-cause mortality was observed (95% CI: 1.051-1.313; P = 0.005) during a median follow-up time of 88 months. Conclusions: In patients with severe primary MR, a novel classification system based on extra–mitral valve cardiac involvement may help refine risk stratification and timing of surgery, particularly including severe LA dilatation and RV dysfunction in the assessment.
KW - mitral valve surgery
KW - primary mitral regurgitation
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=85125460034&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcmg.2021.11.009
DO - https://doi.org/10.1016/j.jcmg.2021.11.009
M3 - Article
C2 - 35033499
SN - 1936-878X
VL - 15
SP - 961
EP - 970
JO - JACC. Cardiovascular imaging
JF - JACC. Cardiovascular imaging
IS - 6
ER -