TY - JOUR
T1 - Predictors of long-term outcomes in patients with significant myxomatous mitral regurgitation undergoing exercise echocardiography
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.
PY - 2014/3/25
Y1 - 2014/3/25
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
KW - echocardiography
KW - exercise test
KW - mitral valve insufficiency
KW - outcome assessment (health care)
UR - http://www.scopus.com/inward/record.url?scp=84897108465&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84897108465&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.113.005287
DO - 10.1161/CIRCULATIONAHA.113.005287
M3 - Article
C2 - 24396041
AN - SCOPUS:84897108465
SN - 0009-7322
VL - 129
SP - 1310
EP - 1319
JO - Circulation
JF - Circulation
IS - 12
ER -