Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome

Volha Dziadzko, Mikhail Dziadzko, Jose R. Medina-Inojosa, Giovanni Benfari, Hector I Michelena, Juan A. Crestanello, Joseph Maalouf, Prabin Thapa, Maurice E Sarano

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aims To define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes. Methods and results We identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51% females, with ejection fraction (EF) 49 ± 17%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33 ± 14, 57 ± 11, 61 ± 10%), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98–3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52–2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50–2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3% vs. 59 ± 4% FMR-a, 40 ± 3% OMR, P < 0.0001). Mitral surgery during patients’ lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR. Conclusion Moderate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.

Original languageEnglish (US)
Pages (from-to)2194-2202
Number of pages9
JournalEuropean heart journal
Volume40
Issue number27
DOIs
StatePublished - Jul 14 2019

Fingerprint

Mitral Valve Insufficiency
Odds Ratio
Mortality
Heart Failure
Ventricular Remodeling
Atrial Fibrillation
Dilatation
Clinical Trials

Keywords

  • Cause
  • Doppler echocardiography
  • Mechanism
  • Mitral regurgitation
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Causes and mechanisms of isolated mitral regurgitation in the community : Clinical context and outcome. / Dziadzko, Volha; Dziadzko, Mikhail; Medina-Inojosa, Jose R.; Benfari, Giovanni; Michelena, Hector I; Crestanello, Juan A.; Maalouf, Joseph; Thapa, Prabin; Sarano, Maurice E.

In: European heart journal, Vol. 40, No. 27, 14.07.2019, p. 2194-2202.

Research output: Contribution to journalArticle

Dziadzko, V, Dziadzko, M, Medina-Inojosa, JR, Benfari, G, Michelena, HI, Crestanello, JA, Maalouf, J, Thapa, P & Sarano, ME 2019, 'Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome', European heart journal, vol. 40, no. 27, pp. 2194-2202. https://doi.org/10.1093/eurheartj/ehz314
Dziadzko, Volha ; Dziadzko, Mikhail ; Medina-Inojosa, Jose R. ; Benfari, Giovanni ; Michelena, Hector I ; Crestanello, Juan A. ; Maalouf, Joseph ; Thapa, Prabin ; Sarano, Maurice E. / Causes and mechanisms of isolated mitral regurgitation in the community : Clinical context and outcome. In: European heart journal. 2019 ; Vol. 40, No. 27. pp. 2194-2202.
@article{d1a5183282c24c0692ae3de4eb9aad43,
title = "Causes and mechanisms of isolated mitral regurgitation in the community: Clinical context and outcome",
abstract = "Aims To define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes. Methods and results We identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51{\%} females, with ejection fraction (EF) 49 ± 17{\%}. MR was functional (FMR) in 65{\%}, organic (OMR) in 32{\%} and 2{\%} mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38{\%} and isolated atrial dilatation (FMR-a) 27{\%}. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51{\%}), atrial-fibrillation (28, 54, 13{\%}), EF (33 ± 14, 57 ± 11, 61 ± 10{\%}), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38{\%}, Type II (excessive valve-movement) 25{\%}, Type IIIa (diastolic movement-restriction) 3{\%}, and Type IIIb (systolic movement-restriction) 34{\%}. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98–3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52–2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50–2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3{\%} vs. 59 ± 4{\%} FMR-a, 40 ± 3{\%} OMR, P < 0.0001). Mitral surgery during patients’ lifetime was performed in 4{\%} of FMR-v, 3{\%} of FMR-a, and 37{\%} of OMR. Conclusion Moderate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.",
keywords = "Cause, Doppler echocardiography, Mechanism, Mitral regurgitation, Mortality",
author = "Volha Dziadzko and Mikhail Dziadzko and Medina-Inojosa, {Jose R.} and Giovanni Benfari and Michelena, {Hector I} and Crestanello, {Juan A.} and Joseph Maalouf and Prabin Thapa and Sarano, {Maurice E}",
year = "2019",
month = "7",
day = "14",
doi = "10.1093/eurheartj/ehz314",
language = "English (US)",
volume = "40",
pages = "2194--2202",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "27",

}

TY - JOUR

T1 - Causes and mechanisms of isolated mitral regurgitation in the community

T2 - Clinical context and outcome

AU - Dziadzko, Volha

AU - Dziadzko, Mikhail

AU - Medina-Inojosa, Jose R.

AU - Benfari, Giovanni

AU - Michelena, Hector I

AU - Crestanello, Juan A.

AU - Maalouf, Joseph

AU - Thapa, Prabin

AU - Sarano, Maurice E

PY - 2019/7/14

Y1 - 2019/7/14

N2 - Aims To define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes. Methods and results We identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51% females, with ejection fraction (EF) 49 ± 17%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33 ± 14, 57 ± 11, 61 ± 10%), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98–3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52–2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50–2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3% vs. 59 ± 4% FMR-a, 40 ± 3% OMR, P < 0.0001). Mitral surgery during patients’ lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR. Conclusion Moderate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.

AB - Aims To define the hitherto unknown aetiology/mechanism distributions of mitral regurgitation (MR) in the community and the linked clinical characteristics/outcomes. Methods and results We identified all isolated, moderate/severe MR diagnosed in our community (Olmsted County, MN, USA) between 2000 and 2010 and classified MR aetiology/mechanisms. Eligible patients (n = 727) were 73 ± 18 years, 51% females, with ejection fraction (EF) 49 ± 17%. MR was functional (FMR) in 65%, organic (OMR) in 32% and 2% mixed. Functional MR was linked to left ventricular remodelling (FMR-v) 38% and isolated atrial dilatation (FMR-a) 27%. At diagnosis FMR-v vs. FMR-a, vs. OMR displayed profound differences (all P < 0.0001) in age (73 ± 14, 80 ± 10, 68 ± 21years), male-sex (59, 33, 51%), atrial-fibrillation (28, 54, 13%), EF (33 ± 14, 57 ± 11, 61 ± 10%), and regurgitant-volume (38 ± 13, 37 ± 11, 51 ± 24 mL/beat). Dominant MR mechanism was Type I (normal valve-movement) 38%, Type II (excessive valve-movement) 25%, Type IIIa (diastolic movement-restriction) 3%, and Type IIIb (systolic movement-restriction) 34%. Outcomes were mediocre with excess-mortality vs. general-population in FMR-v [risk ratio 3.45 (2.98–3.99), P < 0.0001] but also FMR-a [risk ratio 1.88 (1.52–2.25), P < 0.0001] and OMR [risk ratio 1.83 (1.50–2.22), P < 0.0001]. Heart failure was frequent, particularly in FMR-v (5-year 83 ± 3% vs. 59 ± 4% FMR-a, 40 ± 3% OMR, P < 0.0001). Mitral surgery during patients’ lifetime was performed in 4% of FMR-v, 3% of FMR-a, and 37% of OMR. Conclusion Moderate/severe isolated MR in the community displays considerable aetiology/mechanism heterogeneity. Functional MR dominates, mostly FMR-v but FMR-a is frequent and degenerative MR dominates OMR. Outcomes are mediocre with excess-mortality particularly with FMR-v but FMR-a, despite normal EF incurs notable excess-mortality and frequent heart failure. Pervasive undertreatment warrants clinical trials of therapies tailored to specific MR cause/mechanisms.

KW - Cause

KW - Doppler echocardiography

KW - Mechanism

KW - Mitral regurgitation

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=85070082464&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070082464&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehz314

DO - 10.1093/eurheartj/ehz314

M3 - Article

C2 - 31121021

AN - SCOPUS:85070082464

VL - 40

SP - 2194

EP - 2202

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 27

ER -