TY - JOUR
T1 - Long-term mortality in patients with severe secondary mitral regurgitation and normal left ventricular ejection fraction
T2 - Interventional perspective
AU - Barakat, Amr F.
AU - Raza, Mohammad Q.
AU - Banerjee, Kinjal
AU - Tsutsui, Rayji S.
AU - Mentias, Amgad
AU - Rehman, Karim Abdur
AU - Thakkar, Badal
AU - Gul, Sajjad
AU - Faruqui, Raquib
AU - Krishnaswamy, Amar
AU - Rodriguez, Leonardo L.
AU - Grimm, Richard
AU - Griffin, Brian
AU - Tuzcu, Emin Murat
AU - Kapadia, Samir R.
N1 - Publisher Copyright:
© Europa Digital & Publishing 2018. All rights reserved.
PY - 2018/3
Y1 - 2018/3
N2 - 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.
AB - 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.
KW - Mitral regurgitation
KW - Mitral valve disease
KW - Other
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U2 - 10.4244/EIJ-D-17-00561
DO - 10.4244/EIJ-D-17-00561
M3 - Article
C2 - 29313818
AN - SCOPUS:85045918144
SN - 1774-024X
VL - 13
SP - 1881
EP - 1888
JO - EuroIntervention
JF - EuroIntervention
IS - 16
ER -