Long-term outcomes of mitral regurgitation by type and severity - 06/09/18
, Linda K. Shaw, MS b, Matthew Phelan, MS b, Donald D. Glower, MD a, Mads Ersboll, MD, PhD c, John H. Toptine, RDCS a, John H. Alexander, MD a, b, Joseph A. Kisslo, MD a, Andrew Wang, MD a, Daniel B. Mark, MD, MPH a, b, Eric J. Velazquez, MD a, bAbstract |
Background |
We aimed to determine the association of MR severity and type with all-cause death in a large, real-world, clinical setting.
Methods |
We reviewed full echocardiography studies at Duke Echocardiography Laboratory (01/01/1995–12/31/2010), classifying MR based on valve morphology, presence of coronary artery disease, and left ventricular size and function. Survival was compared among patients stratified by MR type and baseline severity.
Results |
Of 93,007 qualifying patients, 32,137 (34.6%) had ≥mild MR. A total of 8094 (8.7%) had moderate/severe MR, which was primary myxomatous (14.1%), primary non-myxomatous (6.2%), secondary non-ischemic (17.0%), and secondary ischemic (49.4%). At 10 years, patients with primary myxomatous MR or MR due to indeterminate cause had survival rates of >60%; primary non-myxomatous, secondary ischemic, and non-ischemic MR had survival rates <50%. While mild (HR 1.06, 95% CI 1.03–1.09), moderate (HR 1.31, 95% CI 1.27–1.37), and severe (HR 1.55, 95% CI 1.46–1.65) MR were independently associated with all-cause death, the relationship of increasing MR severity with mortality varied across MR types (P ≤ .001 for interaction); the highest risk associated with worsening severity was seen in primary myxomatous MR followed by secondary ischemic MR and primary non-myxomatous MR.
Conclusions |
Although MR severity is independently associated with increased all-cause death risk for most forms of MR, the absolute mortality rates associated with worse MR severity are much higher for primary myxomatous, non-myxomatous, and secondary ischemic MR. The findings from this study support carefully defining MR by type and severity.
Le texte complet de cet article est disponible en PDF.Plan
| Blase A. Carabello, MD served as guest editor for this article. |
Vol 203
P. 39-48 - septembre 2018 Retour au numéro
Article précédent
- Patterns of glucose-lowering medication use in patients with type 2 diabetes and heart failure. Insights from the Diabetes Collaborative Registry (DCR)
- Suzanne V. Arnold, Justin B. Echouffo-Tcheugui, Carolyn SP Lam, Silvio E Inzucchi, Fengming Tang, Darren K McGuire, Abhinav Goyal, Thomas M Maddox, Laurence S Sperling, Gregg C Fonarow, Frederick A Masoudi, Mikhail Kosiborod
- Cardiac systolic dysfunction in past illicit users of anabolic androgenic steroids
- Jon J. Rasmussen, Morten Schou, Per L. Madsen, Christian Selmer, Marie L. Johansen, Peter S. Ulriksen, Tina Dreyer, Thomas Kümler, Louis L. Plesner, Jens Faber, Finn Gustafsson, Caroline Kistorp
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?