Clinical and echocardiographic parameters associated with outcomes in patients with moderate secondary mitral regurgitation.

IF 5.1 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart Pub Date : 2024-10-04 DOI:10.1136/heartjnl-2024-324526
Camille Sarrazyn, Federico Fortuni, Dorien Laenens, Aileen Paula Chua, Maria Pilar Lopez Santi, Rinchyenkhand Myagmardorj, Takeru Nabeta, Maria Chiara Meucci, Gurpreet Kaur Singh, Bart Josephus Johannes Velders, Xavier Galloo, Jeroen Joost Bax, Nina Ajmone Marsan
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引用次数: 0

Abstract

Background: Significant secondary mitral regurgitation (SMR) is known to be associated with worse prognosis. However, data focusing specifically on moderate SMR and associated risk factors are lacking. In the present study, clinical and echocardiographic parameters associated with outcomes were evaluated in a large cohort of patients with moderate SMR.

Methods: Patients with moderate SMR were retrospectively included and stratified by New York Heart Association (NYHA) class and specific aetiology (atrial SMR (aSMR) or ventricular SMR (vSMR)) with a further classification of vSMR based on left ventricular ejection fraction (LVEF) ≥40% or <40%. The primary endpoint was all-cause mortality and the secondary endpoint was the composite of all-cause mortality and heart failure (HF) events.

Results: Of the total 1061 patients with moderate SMR (age 69±11 years, 59% male) included, 854 (80%) were in NYHA class I-II and 207 (20%) were in NYHA class III-IV. Regarding the aetiology, 352 (33%) had aSMR and 709 (67%) had vSMR, of which 329 (46%) had LVEF ≥40% and 380 (54%) had LVEF <40%. During a median follow-up of 82 (IQR 55-115) months, 397 (37%) died and 539 (51%) patients had HF events or died. On multivariable analysis, NYHA class III-IV (HR 1.578; 95% CI 1.244 to 2.002, p<0.001) and SMR aetiology were independently associated with both endpoints. Specifically, compared to aSMR, vSMR with LVEF ≥40% had a HR of 1.528 (95% CI 1.108 to 2.106, p=0.010) and vSMR with LVEF <40% had a HR of 1.960 (95% CI 1.434 to 2.679, p<0.001). To further support these findings, patients were matched for (1) NYHA class and (2) SMR aetiology by propensity scores including age, sex, diabetes, chronic obstructive pulmonary disease, renal function, left atrial volume index, NYHA class (only for SMR aetiology matching), LVEF, SMR aetiology (only for NYHA class matching), tricuspid regurgitation severity and right ventricular pulmonary artery coupling index. After matching, NYHA class and SMR aetiology remained associated with both outcomes (for both: log rank p<0.050).

Conclusion: In patients with moderate SMR, distinction in SMR aetiology and assessment of symptoms are important independent determinants of outcome.

与中度继发性二尖瓣反流患者预后相关的临床和超声心动图参数。
背景:众所周知,严重的继发性二尖瓣反流(SMR)与较差的预后有关。然而,目前还缺乏专门针对中度二尖瓣反流及相关风险因素的数据。本研究评估了一大批中度二尖瓣反流患者与预后相关的临床和超声心动图参数:方法:回顾性纳入中度 SMR 患者,并按纽约心脏协会(NYHA)分级和具体病因(心房 SMR(aSMR)或心室 SMR(vSMR))进行分层,根据左室射血分数(LVEF)≥40% 或结果对 vSMR 进一步分类:在总共 1061 名中度 SMR 患者(年龄为 69±11 岁,59% 为男性)中,854 人(80%)属于 NYHA I-II 级,207 人(20%)属于 NYHA III-IV 级。病因方面,352 例(33%)为 aSMR,709 例(67%)为 vSMR,其中 329 例(46%)LVEF ≥40%,380 例(54%)LVEF 结论:在中度 SMR 患者中,区分 SMR 病因和评估症状是预后的重要独立决定因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Heart
Heart 医学-心血管系统
CiteScore
10.30
自引率
5.30%
发文量
320
审稿时长
3-6 weeks
期刊介绍: Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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