Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography.

IF 5.1 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Pub Date : 2025-01-31 DOI:10.1136/heartjnl-2024-324790

David Playford, Simon Stewart, Sarah Ann Harris, Gregory Scalia, David S Celermajer, Liza Thomas, Elizabeth Davida Paratz, Yih-Kai Chan, Geoff Strange

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引用次数: 0

Abstract

Background: Although the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort.

Methods: Echocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events).

Results: There were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years).

Conclusions: Within a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology.

Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12617001387314).

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608570名接受超声心动图检查的男性和女性与中度和重度二尖瓣反流相关的死亡率

背景：尽管严重二尖瓣反流（MR）的预后意义已得到充分认识，但在中度MR中却不太清楚。因此，我们在澳大利亚国家超声心动图数据库的大型队列中探讨了中度和重度MR对预后的影响。方法：使用自然语言处理技术对608570例患者的超声心动图报告进行检查，以确定MR严重程度和小叶病理。心房（aFMR）或心室（vFMR）功能MR评估未报告小叶病理的患者。使用中位1541 （IQR 820至2629）天的个体数据链接，我们检查了MR严重程度与全因（153 612/25.2%事件）和心血管相关死亡率（47 840/7.9%事件）之间的关联。结果：男性319 808例，女性288 762例，年龄62.1±18.5岁，其中末次超声无/轻微、轻、中、重度MR分别为456989例（75.1%）、102 950例（16.9%）、38 504例（6.3%）、10 127例（1.7%）。与无/轻微MR患者相比（26.5%有小叶病理，19.2%死亡），小叶病理（分别为51.8%和78.9%）和实际5年全因死亡率（分别为54.6%和67.5%）随MR严重程度而升高。在调整后的基础上（年龄、性别和小叶病理），中度和重度MR病例的长期死亡率分别高出1.67倍（95% CI 1.65至1.70）和2.36倍（95% CI 2.30至2.42）。结论：在一个大型真实世界的临床队列中，我们证实保守治疗的严重MR与不良预后相关。我们进一步揭示中度MR与死亡率增加相关，与潜在的病因无关。试验注册：澳大利亚新西兰临床试验注册中心（ACTRN12617001387314）。

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 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.