Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

MIDA Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.

Original languageEnglish (US)
Pages (from-to)264-274
Number of pages11
JournalJournal of the American College of Cardiology
Volume73
Issue number3
DOIs
StatePublished - Jan 29 2019

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Mitral Valve Insufficiency
Atrial Fibrillation
Survival
Mortality
Registries

Keywords

  • atrial fibrillation
  • mitral regurgitation
  • mitral repair
  • percutaneous treatment
  • prognosis
  • surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation. / MIDA Investigators.

In: Journal of the American College of Cardiology, Vol. 73, No. 3, 29.01.2019, p. 264-274.

Research output: Contribution to journalArticle

@article{3753da2092b740ca8290a83ab6c03eb6,
title = "Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation",
abstract = "Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 ± 13 years; 71{\%} male, 67{\%} asymptomatic, ejection fraction 64 ± 10{\%}), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1{\%}, 59 ± 3{\%}, and 46 ± 2{\%}, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88{\%}) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95{\%} confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1{\%}, 70 ± 4{\%}, and 57 ± 3{\%}, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.",
keywords = "atrial fibrillation, mitral regurgitation, mitral repair, percutaneous treatment, prognosis, surgery",
author = "{MIDA Investigators} and Francesco Grigioni and Giovanni Benfari and Vanoverschelde, {Jean Louis} and Christophe Tribouilloy and Avierinos, {Jean Francois} and Francesca Bursi and Suri, {Rakesh M.} and Federico Guerra and Agn{\'e}s Pasquet and Dan Rusinaru and Emanuela Marcelli and Alexis Th{\'e}ron and Andrea Barbieri and Hector Michelena and Siham Lazam and Catherine Szymanski and Nkomo, {Vuyisile T} and Alessandro Capucci and Prabin Thapa and Sarano, {Maurice E} and R. Suri and Clavel, {M. A.} and J. Maalouf and Michelena, {Hector I} and M. Enriquez-Sarano and C. Tribouilloy and F. Trojette and C. Szymanski and D. Rusinaru and G. Touati and Remadi, {J. P.} and F. Guerra and A. Capucci and F. Grigioni and A. Russo and E. Biagini and F. Pasquale and M. Ferlito and C. Rapezzi and C. Savini and G. Marinelli and D. Pacini and Gargiulo, {G. D.} and {Di Bartolomeo}, R. and J. Boulif and {de Meester}, C. and {El Khoury}, G. and B. Gerber and S. Lazam and A. Pasquet",
year = "2019",
month = "1",
day = "29",
doi = "10.1016/j.jacc.2018.10.067",
language = "English (US)",
volume = "73",
pages = "264--274",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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TY - JOUR

T1 - Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

AU - MIDA Investigators

AU - Grigioni, Francesco

AU - Benfari, Giovanni

AU - Vanoverschelde, Jean Louis

AU - Tribouilloy, Christophe

AU - Avierinos, Jean Francois

AU - Bursi, Francesca

AU - Suri, Rakesh M.

AU - Guerra, Federico

AU - Pasquet, Agnés

AU - Rusinaru, Dan

AU - Marcelli, Emanuela

AU - Théron, Alexis

AU - Barbieri, Andrea

AU - Michelena, Hector

AU - Lazam, Siham

AU - Szymanski, Catherine

AU - Nkomo, Vuyisile T

AU - Capucci, Alessandro

AU - Thapa, Prabin

AU - Sarano, Maurice E

AU - Suri, R.

AU - Clavel, M. A.

AU - Maalouf, J.

AU - Michelena, Hector I

AU - Enriquez-Sarano, M.

AU - Tribouilloy, C.

AU - Trojette, F.

AU - Szymanski, C.

AU - Rusinaru, D.

AU - Touati, G.

AU - Remadi, J. P.

AU - Guerra, F.

AU - Capucci, A.

AU - Grigioni, F.

AU - Russo, A.

AU - Biagini, E.

AU - Pasquale, F.

AU - Ferlito, M.

AU - Rapezzi, C.

AU - Savini, C.

AU - Marinelli, G.

AU - Pacini, D.

AU - Gargiulo, G. D.

AU - Di Bartolomeo, R.

AU - Boulif, J.

AU - de Meester, C.

AU - El Khoury, G.

AU - Gerber, B.

AU - Lazam, S.

AU - Pasquet, A.

PY - 2019/1/29

Y1 - 2019/1/29

N2 - Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.

AB - Background: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. Objectives: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. Methods: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. Results: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001). Conclusions: AF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery.

KW - atrial fibrillation

KW - mitral regurgitation

KW - mitral repair

KW - percutaneous treatment

KW - prognosis

KW - surgery

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U2 - 10.1016/j.jacc.2018.10.067

DO - 10.1016/j.jacc.2018.10.067

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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