Long-term mortality in patients with severe secondary mitral regurgitation and normal left ventricular ejection fraction: Interventional perspective

Amr F. Barakat, Mohammad Q. Raza, Kinjal Banerjee, Rayji S. Tsutsui, Amgad Mentias, Karim Abdur Rehman, Badal Thakkar, Sajjad Gul, Raquib Faruqui, Amar Krishnaswamy, Leonardo L. Rodriguez, Richard Grimm, Brian Griffin, Emin Murat Tuzcu, Samir R. Kapadia

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Aims: Patients with severe secondary mitral regurgitation (MR) and normal ejection fraction are being excluded from clinical trials evaluating transcatheter mitral devices. We sought to evaluate the long-term mortality with medical management alone in this patient population. Methods and results: We retrospectively evaluated patients diagnosed with ≥3+ MR at our institution over 15 years. Only patients with an ejection fraction ≥60% were included in the study. Those with degenerative mitral valve disease, papillary muscle dysfunction, or hypertrophic cardiomyopathy, and those who underwent mitral valve intervention were excluded. The study included 400 patients (age 71.1±14.8, 25.1% male, ejection fraction 62.5±3.6%). Mechanism of secondary MR was restricted valve motion, annular dilation and apical tethering in 91.5, 4.5 and 4%, respectively. One-year and three-year mortality were 19.1 and 26.3%, respectively. On multivariable Cox proportional regression analysis, older age, New York Heart Association functional Class III or IV, >3+ MR and larger left atrium were independent predictors of mortality. Conclusions: Severe secondary MR with normal left ventricular systolic function has significant mortality with medical management alone. This initial observation needs to be confirmed in larger prospective studies. These patients should be included in future transcatheter clinical trials.

Original languageEnglish (US)
Pages (from-to)1881-1888
Number of pages8
JournalEuroIntervention
Volume13
Issue number16
DOIs
StatePublished - Mar 2018
Externally publishedYes

Keywords

  • Mitral regurgitation
  • Mitral valve disease
  • Other

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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