Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography

Peyman Naji, Brian P. Griffin, Fadi Asfahan, Tyler Barr, L. Leonardo Rodriguez, Richard Grimm, Shikhar Agarwal, William J. Stewart, Tomislav Mihaljevic, A. Marc Gillinov, Milind Y. Desai

Research output: Contribution to journalArticle

Abstract

BACKGROUND - : Significant myxomatous mitral regurgitation leads to progressive left ventricular (LV) decline, resulting in congestive heart failure and death. Such patients benefit from mitral valve surgery. Exercise echocardiography aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing exercise echocardiography. METHODS AND RESULTS - : This is an observational study of 884 consecutive patients (age, 58±14 years; 67% men) with grade III+ or greater myxomatous mitral regurgitation who underwent exercise echocardiography between January 2000 and December 2011 (excluding functional mitral regurgitation, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease, or greater than mild mitral stenosis). Clinical and echocardiographic data (mitral regurgitation, LV ejection fraction, LV dimensions, right ventricular systolic pressure) and exercise variables (metabolic equivalents, heart rate recovery at 1 minute after exercise) were recorded. Composite events of death, myocardial infarction, stroke, and progression to congestive heart failure were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, resting right ventricular systolic pressure, peak stress right ventricular systolic pressure, metabolic equivalents achieved, and heart rate recovery were 58±5%, 1.6±0.4 mm/m, 31±12 mm Hg, 46±17 mm Hg, 9.6±3, and 33±14 beats, respectively. During 6.4±4 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, percent of age/sex-predicted metabolic equivalents (hazard ratio, 0.99; 95% confidence interval, 0.98-0.99; P=0.005), heart rate recovery (hazard ratio, 0.29; 95% confidence interval, 0.17-0.50; P

Original languageEnglish (US)
Pages (from-to)1310-1319
Number of pages10
JournalCirculation
Volume129
Issue number12
DOIs
StatePublished - Mar 25 2014
Externally publishedYes

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Mitral Valve Insufficiency
Echocardiography
Metabolic Equivalent
Exercise
Ventricular Pressure
Heart Rate
Blood Pressure
Stroke Volume
Heart Failure
Confidence Intervals
Mitral Valve Stenosis
Hypertrophic Cardiomyopathy
Rheumatic Diseases
Mitral Valve
Observational Studies
Stroke
Myocardial Infarction

Keywords

  • echocardiography
  • exercise test
  • mitral valve insufficiency
  • outcome assessment (health care)

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Naji, P., Griffin, B. P., Asfahan, F., Barr, T., Rodriguez, L. L., Grimm, R., ... Desai, M. Y. (2014). Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography. Circulation, 129(12), 1310-1319. https://doi.org/10.1161/CIRCULATIONAHA.113.005287

Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography. / Naji, Peyman; Griffin, Brian P.; Asfahan, Fadi; Barr, Tyler; Rodriguez, L. Leonardo; Grimm, Richard; Agarwal, Shikhar; Stewart, William J.; Mihaljevic, Tomislav; Gillinov, A. Marc; Desai, Milind Y.

In: Circulation, Vol. 129, No. 12, 25.03.2014, p. 1310-1319.

Research output: Contribution to journalArticle

Naji, P, Griffin, BP, Asfahan, F, Barr, T, Rodriguez, LL, Grimm, R, Agarwal, S, Stewart, WJ, Mihaljevic, T, Gillinov, AM & Desai, MY 2014, 'Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography', Circulation, vol. 129, no. 12, pp. 1310-1319. https://doi.org/10.1161/CIRCULATIONAHA.113.005287
Naji, Peyman ; Griffin, Brian P. ; Asfahan, Fadi ; Barr, Tyler ; Rodriguez, L. Leonardo ; Grimm, Richard ; Agarwal, Shikhar ; Stewart, William J. ; Mihaljevic, Tomislav ; Gillinov, A. Marc ; Desai, Milind Y. / Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography. In: Circulation. 2014 ; Vol. 129, No. 12. pp. 1310-1319.
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abstract = "BACKGROUND - : Significant myxomatous mitral regurgitation leads to progressive left ventricular (LV) decline, resulting in congestive heart failure and death. Such patients benefit from mitral valve surgery. Exercise echocardiography aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing exercise echocardiography. METHODS AND RESULTS - : This is an observational study of 884 consecutive patients (age, 58±14 years; 67{\%} men) with grade III+ or greater myxomatous mitral regurgitation who underwent exercise echocardiography between January 2000 and December 2011 (excluding functional mitral regurgitation, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease, or greater than mild mitral stenosis). Clinical and echocardiographic data (mitral regurgitation, LV ejection fraction, LV dimensions, right ventricular systolic pressure) and exercise variables (metabolic equivalents, heart rate recovery at 1 minute after exercise) were recorded. Composite events of death, myocardial infarction, stroke, and progression to congestive heart failure were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, resting right ventricular systolic pressure, peak stress right ventricular systolic pressure, metabolic equivalents achieved, and heart rate recovery were 58±5{\%}, 1.6±0.4 mm/m, 31±12 mm Hg, 46±17 mm Hg, 9.6±3, and 33±14 beats, respectively. During 6.4±4 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, percent of age/sex-predicted metabolic equivalents (hazard ratio, 0.99; 95{\%} confidence interval, 0.98-0.99; P=0.005), heart rate recovery (hazard ratio, 0.29; 95{\%} confidence interval, 0.17-0.50; P",
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AU - Naji, Peyman

AU - Griffin, Brian P.

AU - Asfahan, Fadi

AU - Barr, Tyler

AU - Rodriguez, L. Leonardo

AU - Grimm, Richard

AU - Agarwal, Shikhar

AU - Stewart, William J.

AU - Mihaljevic, Tomislav

AU - Gillinov, A. Marc

AU - Desai, Milind Y.

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N2 - BACKGROUND - : Significant myxomatous mitral regurgitation leads to progressive left ventricular (LV) decline, resulting in congestive heart failure and death. Such patients benefit from mitral valve surgery. Exercise echocardiography aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing exercise echocardiography. METHODS AND RESULTS - : This is an observational study of 884 consecutive patients (age, 58±14 years; 67% men) with grade III+ or greater myxomatous mitral regurgitation who underwent exercise echocardiography between January 2000 and December 2011 (excluding functional mitral regurgitation, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease, or greater than mild mitral stenosis). Clinical and echocardiographic data (mitral regurgitation, LV ejection fraction, LV dimensions, right ventricular systolic pressure) and exercise variables (metabolic equivalents, heart rate recovery at 1 minute after exercise) were recorded. Composite events of death, myocardial infarction, stroke, and progression to congestive heart failure were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, resting right ventricular systolic pressure, peak stress right ventricular systolic pressure, metabolic equivalents achieved, and heart rate recovery were 58±5%, 1.6±0.4 mm/m, 31±12 mm Hg, 46±17 mm Hg, 9.6±3, and 33±14 beats, respectively. During 6.4±4 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, percent of age/sex-predicted metabolic equivalents (hazard ratio, 0.99; 95% confidence interval, 0.98-0.99; P=0.005), heart rate recovery (hazard ratio, 0.29; 95% confidence interval, 0.17-0.50; P

AB - BACKGROUND - : Significant myxomatous mitral regurgitation leads to progressive left ventricular (LV) decline, resulting in congestive heart failure and death. Such patients benefit from mitral valve surgery. Exercise echocardiography aids in risk stratification and helps decide surgical timing. We sought to assess predictors of outcomes in such patients undergoing exercise echocardiography. METHODS AND RESULTS - : This is an observational study of 884 consecutive patients (age, 58±14 years; 67% men) with grade III+ or greater myxomatous mitral regurgitation who underwent exercise echocardiography between January 2000 and December 2011 (excluding functional mitral regurgitation, prior valvular surgery, hypertrophic cardiomyopathy, rheumatic valvular disease, or greater than mild mitral stenosis). Clinical and echocardiographic data (mitral regurgitation, LV ejection fraction, LV dimensions, right ventricular systolic pressure) and exercise variables (metabolic equivalents, heart rate recovery at 1 minute after exercise) were recorded. Composite events of death, myocardial infarction, stroke, and progression to congestive heart failure were recorded. Mean LV ejection fraction, indexed LV end-systolic dimension, resting right ventricular systolic pressure, peak stress right ventricular systolic pressure, metabolic equivalents achieved, and heart rate recovery were 58±5%, 1.6±0.4 mm/m, 31±12 mm Hg, 46±17 mm Hg, 9.6±3, and 33±14 beats, respectively. During 6.4±4 years of follow-up, there were 87 events. On stepwise multivariable Cox analysis, percent of age/sex-predicted metabolic equivalents (hazard ratio, 0.99; 95% confidence interval, 0.98-0.99; P=0.005), heart rate recovery (hazard ratio, 0.29; 95% confidence interval, 0.17-0.50; P

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