TY - JOUR
T1 - Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets. A Long-Term Follow-Up Multicenter Study
AU - Tribouilloy, Christophe
AU - Grigioni, Francesco
AU - Avierinos, Jean François
AU - Barbieri, Andrea
AU - Rusinaru, Dan
AU - Szymanski, Catherine
AU - Ferlito, Marinella
AU - Tafanelli, Laurence
AU - Bursi, Francesca
AU - Trojette, Faouzi
AU - Branzi, Angelo
AU - Habib, Gilbert
AU - Modena, Maria G.
AU - Enriquez-Sarano, Maurice
N1 - Funding Information:
Supported by a grant from the University of Bologna, Italy, donated by the Foundation Luisa Fanti Melloni and contributions from the Banca del Monte Foundation, Italy. Dr. Grigioni has received honoraria and travel grants from Edwards Lifesciences. Dr. Enriquez-Sarano is a consultant for and has received grants from Pfizer, AstraZeneca, and Edwards Lifesciences.
PY - 2009/11/17
Y1 - 2009/11/17
N2 - Objectives: This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets. Background: LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown. Methods: The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 ± 12 years; ejection fraction: 65 ± 10%) in whom LVESD was measured (36 ± 7 mm). Results: Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus ≥40 mm (64 ± 5% vs. 48 ± 10%; p < 0.001, and 73 ± 5% vs. 63 ± 10%; p = 0.001). LVESD ≥40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD ≥40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD ≥40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death). Conclusions: In MR due to flail leaflets, LVESD ≥40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD ≥40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.
AB - Objectives: This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets. Background: LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown. Methods: The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 ± 12 years; ejection fraction: 65 ± 10%) in whom LVESD was measured (36 ± 7 mm). Results: Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus ≥40 mm (64 ± 5% vs. 48 ± 10%; p < 0.001, and 73 ± 5% vs. 63 ± 10%; p = 0.001). LVESD ≥40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD ≥40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD ≥40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death). Conclusions: In MR due to flail leaflets, LVESD ≥40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD ≥40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.
KW - left ventricular size
KW - mitral regurgitation
KW - surgery
KW - survival
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U2 - 10.1016/j.jacc.2009.06.047
DO - 10.1016/j.jacc.2009.06.047
M3 - Article
C2 - 19909877
AN - SCOPUS:70350707152
SN - 0735-1097
VL - 54
SP - 1961
EP - 1968
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -