Clinical outcome of mitral regurgitation due to flail leaflet

Lieng H. Ling, Maurice E Sarano, James B. Seward, A. Jamil Tajik, Hartzell V Schaff, Kent R Bailey, Robert L. Frye

Research output: Contribution to journalArticle

475 Citations (Scopus)

Abstract

Background: Mitral regurgitation due to flail leaflet is difficult to manage, because it is frequently asymptomatic yet carries a high risk of left ventricular dysfunction and because the natural history of the condition is poorly defined. Methods: We obtained clinical follow-up data through 1994- 1995 in 229 patients with isolated mitral regurgitation due to flail leaflet; this condition was first diagnosed by echocardiography between 1980 and 1989. Results: The 86 patients who were treated medically had a mortality rate significantly higher than expected (6.3 percent yearly, P = 0.016 for the comparison with the expected rate in the U.S. population according to the 1990 census). Independent determinants of mortality were an older age, the presence of symptoms, and a lower ejection fraction. Patients who were even transiently in New York Heart Association functional class III or IV had a high mortality rate (34 percent yearly), but the rate was also notable (4.1 percent yearly) among those in class I or II. At 10 years, the mean (±SE) rates of heart failure, atrial fibrillation, and death or surgery were 63±8, 30±12, and 90±3 percent, respectively. In a multivariate analysis, surgical correction of mitral regurgitation (performed in 143 patients) was associated with a reduced mortality rate (hazard ratio, 0.29; 95 percent confidence interval, 0.15 to 0.56; P<0.001). Conclusions: When treated medically, mitral regurgitation due to flail leaflet is associated with excess mortality and high morbidity. Surgery is almost unavoidable within 10 years after the diagnosis and appears to be associated with an improved prognosis; this finding suggests that surgery should be considered early in the course of the disease.

Original languageEnglish (US)
Pages (from-to)1417-1423
Number of pages7
JournalNew England Journal of Medicine
Volume335
Issue number19
DOIs
StatePublished - Nov 7 1996

Fingerprint

Mitral Valve Insufficiency
Mortality
Left Ventricular Dysfunction
Censuses
Natural History
Atrial Fibrillation
Echocardiography
Multivariate Analysis
Heart Failure
Confidence Intervals
Morbidity
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical outcome of mitral regurgitation due to flail leaflet. / Ling, Lieng H.; Sarano, Maurice E; Seward, James B.; Tajik, A. Jamil; Schaff, Hartzell V; Bailey, Kent R; Frye, Robert L.

In: New England Journal of Medicine, Vol. 335, No. 19, 07.11.1996, p. 1417-1423.

Research output: Contribution to journalArticle

Ling, Lieng H. ; Sarano, Maurice E ; Seward, James B. ; Tajik, A. Jamil ; Schaff, Hartzell V ; Bailey, Kent R ; Frye, Robert L. / Clinical outcome of mitral regurgitation due to flail leaflet. In: New England Journal of Medicine. 1996 ; Vol. 335, No. 19. pp. 1417-1423.
@article{6737add67a3e4eb9bb85cba48c1d59b5,
title = "Clinical outcome of mitral regurgitation due to flail leaflet",
abstract = "Background: Mitral regurgitation due to flail leaflet is difficult to manage, because it is frequently asymptomatic yet carries a high risk of left ventricular dysfunction and because the natural history of the condition is poorly defined. Methods: We obtained clinical follow-up data through 1994- 1995 in 229 patients with isolated mitral regurgitation due to flail leaflet; this condition was first diagnosed by echocardiography between 1980 and 1989. Results: The 86 patients who were treated medically had a mortality rate significantly higher than expected (6.3 percent yearly, P = 0.016 for the comparison with the expected rate in the U.S. population according to the 1990 census). Independent determinants of mortality were an older age, the presence of symptoms, and a lower ejection fraction. Patients who were even transiently in New York Heart Association functional class III or IV had a high mortality rate (34 percent yearly), but the rate was also notable (4.1 percent yearly) among those in class I or II. At 10 years, the mean (±SE) rates of heart failure, atrial fibrillation, and death or surgery were 63±8, 30±12, and 90±3 percent, respectively. In a multivariate analysis, surgical correction of mitral regurgitation (performed in 143 patients) was associated with a reduced mortality rate (hazard ratio, 0.29; 95 percent confidence interval, 0.15 to 0.56; P<0.001). Conclusions: When treated medically, mitral regurgitation due to flail leaflet is associated with excess mortality and high morbidity. Surgery is almost unavoidable within 10 years after the diagnosis and appears to be associated with an improved prognosis; this finding suggests that surgery should be considered early in the course of the disease.",
author = "Ling, {Lieng H.} and Sarano, {Maurice E} and Seward, {James B.} and Tajik, {A. Jamil} and Schaff, {Hartzell V} and Bailey, {Kent R} and Frye, {Robert L.}",
year = "1996",
month = "11",
day = "7",
doi = "10.1056/NEJM199611073351902",
language = "English (US)",
volume = "335",
pages = "1417--1423",
journal = "New England Journal of Medicine",
issn = "1533-4406",
publisher = "Massachussetts Medical Society",
number = "19",

}

TY - JOUR

T1 - Clinical outcome of mitral regurgitation due to flail leaflet

AU - Ling, Lieng H.

AU - Sarano, Maurice E

AU - Seward, James B.

AU - Tajik, A. Jamil

AU - Schaff, Hartzell V

AU - Bailey, Kent R

AU - Frye, Robert L.

PY - 1996/11/7

Y1 - 1996/11/7

N2 - Background: Mitral regurgitation due to flail leaflet is difficult to manage, because it is frequently asymptomatic yet carries a high risk of left ventricular dysfunction and because the natural history of the condition is poorly defined. Methods: We obtained clinical follow-up data through 1994- 1995 in 229 patients with isolated mitral regurgitation due to flail leaflet; this condition was first diagnosed by echocardiography between 1980 and 1989. Results: The 86 patients who were treated medically had a mortality rate significantly higher than expected (6.3 percent yearly, P = 0.016 for the comparison with the expected rate in the U.S. population according to the 1990 census). Independent determinants of mortality were an older age, the presence of symptoms, and a lower ejection fraction. Patients who were even transiently in New York Heart Association functional class III or IV had a high mortality rate (34 percent yearly), but the rate was also notable (4.1 percent yearly) among those in class I or II. At 10 years, the mean (±SE) rates of heart failure, atrial fibrillation, and death or surgery were 63±8, 30±12, and 90±3 percent, respectively. In a multivariate analysis, surgical correction of mitral regurgitation (performed in 143 patients) was associated with a reduced mortality rate (hazard ratio, 0.29; 95 percent confidence interval, 0.15 to 0.56; P<0.001). Conclusions: When treated medically, mitral regurgitation due to flail leaflet is associated with excess mortality and high morbidity. Surgery is almost unavoidable within 10 years after the diagnosis and appears to be associated with an improved prognosis; this finding suggests that surgery should be considered early in the course of the disease.

AB - Background: Mitral regurgitation due to flail leaflet is difficult to manage, because it is frequently asymptomatic yet carries a high risk of left ventricular dysfunction and because the natural history of the condition is poorly defined. Methods: We obtained clinical follow-up data through 1994- 1995 in 229 patients with isolated mitral regurgitation due to flail leaflet; this condition was first diagnosed by echocardiography between 1980 and 1989. Results: The 86 patients who were treated medically had a mortality rate significantly higher than expected (6.3 percent yearly, P = 0.016 for the comparison with the expected rate in the U.S. population according to the 1990 census). Independent determinants of mortality were an older age, the presence of symptoms, and a lower ejection fraction. Patients who were even transiently in New York Heart Association functional class III or IV had a high mortality rate (34 percent yearly), but the rate was also notable (4.1 percent yearly) among those in class I or II. At 10 years, the mean (±SE) rates of heart failure, atrial fibrillation, and death or surgery were 63±8, 30±12, and 90±3 percent, respectively. In a multivariate analysis, surgical correction of mitral regurgitation (performed in 143 patients) was associated with a reduced mortality rate (hazard ratio, 0.29; 95 percent confidence interval, 0.15 to 0.56; P<0.001). Conclusions: When treated medically, mitral regurgitation due to flail leaflet is associated with excess mortality and high morbidity. Surgery is almost unavoidable within 10 years after the diagnosis and appears to be associated with an improved prognosis; this finding suggests that surgery should be considered early in the course of the disease.

UR - http://www.scopus.com/inward/record.url?scp=0029829379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029829379&partnerID=8YFLogxK

U2 - 10.1056/NEJM199611073351902

DO - 10.1056/NEJM199611073351902

M3 - Article

VL - 335

SP - 1417

EP - 1423

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 1533-4406

IS - 19

ER -