Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet

A multicentre international study

Jean François Avierinos, Christophe Tribouilloy, Francesco Grigioni, Rakesh Suri, Andrea Barbieri, Hector I Michelena, Teresa Ionico, Dan Rusinaru, Sébastien Ansaldi, Gilbert Habib, Catherine Szymanski, Roch Giorgi, Douglas W. Mahoney, Maurice E Sarano

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

AimsDefine the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis.Methods and resultsThe Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥65 years at diagnosis) were compared with the 364 younger (<65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95% confidence interval (95% CI) 4.7 (2.5-10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95% confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6-2.0), P = 0.65], was prominent in older patients [1.4 (1.2-1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5-13.3), P < 0.0001) and in older patients [6.7 (5.6-8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5-10.6), P < 0.0001] than in older patients [3.5 (2.6-4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95% CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4-24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01).ConclusionsBoth older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.

Original languageEnglish (US)
Pages (from-to)2600-2609
Number of pages10
JournalEuropean Heart Journal
Volume34
Issue number33
DOIs
StatePublished - Sep 7 2013

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Mitral Valve Insufficiency
Multicenter Studies
Mortality
Heart Failure
Atrial Fibrillation
Age Groups
Confidence Intervals
Odds Ratio
Morbidity
Registries
Echocardiography
Databases

Keywords

  • Ageing
  • Atrial fibrillation
  • Congestive heart failure
  • Mitral regurgitation
  • Mitral valve surgery
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet : A multicentre international study. / Avierinos, Jean François; Tribouilloy, Christophe; Grigioni, Francesco; Suri, Rakesh; Barbieri, Andrea; Michelena, Hector I; Ionico, Teresa; Rusinaru, Dan; Ansaldi, Sébastien; Habib, Gilbert; Szymanski, Catherine; Giorgi, Roch; Mahoney, Douglas W.; Sarano, Maurice E.

In: European Heart Journal, Vol. 34, No. 33, 07.09.2013, p. 2600-2609.

Research output: Contribution to journalArticle

Avierinos, JF, Tribouilloy, C, Grigioni, F, Suri, R, Barbieri, A, Michelena, HI, Ionico, T, Rusinaru, D, Ansaldi, S, Habib, G, Szymanski, C, Giorgi, R, Mahoney, DW & Sarano, ME 2013, 'Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet: A multicentre international study', European Heart Journal, vol. 34, no. 33, pp. 2600-2609. https://doi.org/10.1093/eurheartj/eht250
Avierinos, Jean François ; Tribouilloy, Christophe ; Grigioni, Francesco ; Suri, Rakesh ; Barbieri, Andrea ; Michelena, Hector I ; Ionico, Teresa ; Rusinaru, Dan ; Ansaldi, Sébastien ; Habib, Gilbert ; Szymanski, Catherine ; Giorgi, Roch ; Mahoney, Douglas W. ; Sarano, Maurice E. / Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet : A multicentre international study. In: European Heart Journal. 2013 ; Vol. 34, No. 33. pp. 2600-2609.
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abstract = "AimsDefine the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis.Methods and resultsThe Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥65 years at diagnosis) were compared with the 364 younger (<65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95{\%} confidence interval (95{\%} CI) 4.7 (2.5-10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95{\%} confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6-2.0), P = 0.65], was prominent in older patients [1.4 (1.2-1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5-13.3), P < 0.0001) and in older patients [6.7 (5.6-8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5-10.6), P < 0.0001] than in older patients [3.5 (2.6-4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95{\%} CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4-24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01).ConclusionsBoth older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.",
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T1 - Impact of ageing on presentation and outcome of mitral regurgitation due to flail leaflet

T2 - A multicentre international study

AU - Avierinos, Jean François

AU - Tribouilloy, Christophe

AU - Grigioni, Francesco

AU - Suri, Rakesh

AU - Barbieri, Andrea

AU - Michelena, Hector I

AU - Ionico, Teresa

AU - Rusinaru, Dan

AU - Ansaldi, Sébastien

AU - Habib, Gilbert

AU - Szymanski, Catherine

AU - Giorgi, Roch

AU - Mahoney, Douglas W.

AU - Sarano, Maurice E

PY - 2013/9/7

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N2 - AimsDefine the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis.Methods and resultsThe Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥65 years at diagnosis) were compared with the 364 younger (<65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95% confidence interval (95% CI) 4.7 (2.5-10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95% confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6-2.0), P = 0.65], was prominent in older patients [1.4 (1.2-1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5-13.3), P < 0.0001) and in older patients [6.7 (5.6-8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5-10.6), P < 0.0001] than in older patients [3.5 (2.6-4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95% CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4-24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01).ConclusionsBoth older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.

AB - AimsDefine the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis.Methods and resultsThe Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥65 years at diagnosis) were compared with the 364 younger (<65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95% confidence interval (95% CI) 4.7 (2.5-10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95% confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6-2.0), P = 0.65], was prominent in older patients [1.4 (1.2-1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5-13.3), P < 0.0001) and in older patients [6.7 (5.6-8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5-10.6), P < 0.0001] than in older patients [3.5 (2.6-4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95% CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4-24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01).ConclusionsBoth older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.

KW - Ageing

KW - Atrial fibrillation

KW - Congestive heart failure

KW - Mitral regurgitation

KW - Mitral valve surgery

KW - Outcome

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