Journal ArticleDOI
Quantitative determinants of the outcome of asymptomatic mitral regurgitation
Maurice Enriquez-Sarano,Jean François Avierinos,David Messika-Zeitoun,Delphine Detaint,Maryann Capps,Vuyisile T. Nkomo,Christopher G. Scott,Hartzell V. Schaff,A. Jamil Tajik +8 more
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TLDR
Quantitative grading of mitral Regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation and patients with an effective regurgitant orifice of at least 40 mm2 should promptly be considered for cardiac surgery.Abstract:
background The clinical outcome of asymptomatic mitral regurgitation is poorly defined, and the treatment is uncertain. We studied the effect on the outcome of quantifying mitral regurgitation according to recent guidelines. methods We prospectively enrolled 456 patients (mean [±SD] age, 63±14 years; 63 percent men; ejection fraction, 70±8 percent) with asymptomatic organic mitral regurgitation, quantified according to current recommendations (regurgitant volume, 66±40 ml per beat; effective regurgitant orifice, 40±27 mm 2 ). results The estimated five-year rates (±SE) of death from any cause, death from cardiac causes, and cardiac events (death from cardiac causes, heart failure, or new atrial fibrillation) with medical management were 22±3 percent, 14±3 percent, and 33±3 percent, respectively. Independent determinants of survival were increasing age, the presence of diabetes, and increasing effective regurgitant orifice (adjusted risk ratio per 10-mm 2 increment, 1.18; 95 percent confidence interval, 1.06 to 1.30; P<0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 had a five-year survival rate that was lower than expected on the basis of U.S. Census data (58±9 percent vs. 78 percent, P=0.03). As compared with patients with a regurgitant orifice of less than 20 mm 2 , those with an orifice of at least 40 mm 2 had an increased risk of death from any cause (adjusted risk ratio, 2.90; 95 percent confidence interval, 1.33 to 6.32; P<0.01), death from cardiac causes (adjusted risk ratio, 5.21; 95 percent confidence interval, 1.98 to 14.40; P<0.01), and cardiac events (adjusted risk ratio, 5.66; 95 percent confidence interval, 3.07 to 10.56; P<0.01). Cardiac surgery was ultimately performed in 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; 95 percent confidence interval, 0.14 to 0.55; P<0.01). conclusions Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 should promptly be considered for cardiac surgery.read more
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Journal ArticleDOI
Outcomes in Mitral Regurgitation Due to Flail Leaflets: A Multicenter European Study
Francesco Grigioni,Christophe Tribouilloy,Jean François Avierinos,Andrea Barbieri,Marinella Ferlito,Faouzi Trojette,Laurence Tafanelli,Angelo Branzi,Catherine Szymanski,Gilbert Habib,Maria Grazia Modena,Maurice Enriquez-Sarano,Mida Investigators +12 more
TL;DR: These findings support surgical consideration in patients with MR due to flail leaflets for whom MV repair is feasible, and nonsurgical management of severe MR was associated with notable rates of adverse events.
Journal ArticleDOI
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary
Robert O. Bonow,Blase A. Carabello,Kanu Chatterjee,Antonio C. de Leon,David P. Faxon,Michael D. Freed,William H. Gaasch,Bruce W. Lytle,Rick A. Nishimura,Patrick T. O'Gara,Robert A. O'Rourke,Catherine M Otto,Pravin M. Shah,Jack S. Shanewise,Sidney C. Smith,Alice K. Jacobs,Cynthia D. Adams,Jeffrey L. Anderson,Elliott M. Antman,Valentin Fuster,Jonathan L. Halperin,Loren F. Hiratzka,Sharon A. Hunt,Bruce W. Lytle,Rick A. Nishimura,Richard L. Page,Barbara Riegel +26 more
Journal ArticleDOI
Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States
Paul Sorajja,Michael J. Mack,Sreekanth Vemulapalli,David R. Holmes,Amanda Stebbins,Saibal Kar,D. Scott Lim,Vinod H. Thourani,Patrick M. McCarthy,Samir R. Kapadia,Paul A. Grayburn,Wesley A. Pedersen,Gorav Ailawadi +12 more
TL;DR: The data support the effectiveness of this therapy in appropriately selected high-risk patients in a commercial setting and further study is required to determine the long-term impact of transcatheter MV repair in this patient population.
Journal ArticleDOI
Exercise-induced changes in degenerative mitral regurgitation.
TL;DR: Degenerative MR might be dynamic and increases during exercise in one-third of patients, and marked changes in MR severity are associated with exercise-induced changes in systolic PAP and reduced symptom-free survival.
Journal ArticleDOI
Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography: Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance
Nina Ajmone Marsan,Jos J.M. Westenberg,Claudia Ypenburg,Victoria Delgado,Rutger J. van Bommel,Stijntje D. Roes,Gaetano Nucifora,Rob J. van der Geest,Albert de Roos,Johan H.C. Reiber,Martin J. Schalij,Jeroen J. Bax +11 more
TL;DR: In this paper, the authors evaluated feasibility and accuracy of real-time 3D echocardiography for quantification of mitral regurgitation (MR), in a head-to-head comparison with velocity-encoded cardiac magnetic resonance (VE-CMR).
References
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Journal ArticleDOI
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease
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Journal ArticleDOI
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography
William A. Zoghbi,Maurice Enriquez-Sarano,Elyse Foster,Paul A. Grayburn,Carol D. Kraft,Robert A. Levine,Petros Nihoyannopoulos,Catherine M Otto,Miguel A. Quinones,Harry Rakowski,William J. Stewart,Alan D. Waggoner,Neil J. Weissman +12 more
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Survival after the onset of congestive heart failure in Framingham Heart Study subjects.
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