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
Reads0
Chats0
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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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
Citations
More filters
Journal ArticleDOI
Prognostic significance of moderate primary mitral regurgitation and concomitant paroxysmal atrial fibrillation.
Hideyuki Hayashi,Yukio Abe,Yusuke Morita,Yuhei Yamaji,Eisaku Nakane,Yoshizumi Haruna,Tetsuya Haruna,Moriaki Inoko +7 more
TL;DR: Patients with moderate D MR and concomitant PAF had a significantly worse outcome compared to those with mild or no MR, and active surveillance and some intervention for patients with PAF and moderate DMR may be required.
Journal ArticleDOI
Color Doppler splay in mitral regurgitation: hemodynamic correlates and outcome in a clinical cohort.
TL;DR: In this article , the authors assessed the prognostic significance of color Doppler splay (CDS) and its hemodynamic correlates in patients with mitral regurgitation (MR) and found that the presence of CDS is associated with more severe MR and worse outcomes.
Journal ArticleDOI
Advances in Echocardiography
TL;DR: Three-dimensional echocardiography, in particular, provides improved tools for quantification both of volumes and of flows, and provides a unique tool for guiding minimally invasive interventions.
Journal ArticleDOI
Mitral Regurgitation and Mortality Risk in Medicare Beneficiaries With Heart Failure and Preserved Ejection Fraction.
Ginger Y. Jiang,Jiaman Xu,Warren J. Manning,Lawrence J. Markson,Kamal R. Khabbaz,Arthur R. Garan,Marwa A. Sabe,Jordan B. Strom +7 more
TL;DR: In this paper , the authors evaluated the relation between mitral regurgitation severity on transthoracic echocardiography (TTE) and subsequent all-cause mortality in Medicare beneficiaries with preserved ejection fraction (HFpEF).
References
More filters
Journal ArticleDOI
A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation☆
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
Journal ArticleDOI
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease
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 +13 more
TL;DR: It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management, and management of diseases.
Journal ArticleDOI
Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.
Nelson B. Schiller,P. M. Shah,Michael H. Crawford,Anthony N. DeMaria,Richard B. Devereux,Harvey Feigenbaum,H. Gutgesell,Nathaniel Reichek,David J. Sahn,Ingela Schnittger +9 more
TL;DR: It is the opinion that current technology justifies the clinical use of the quantitative two-dimensional methods described in this article and the routine reporting of left ventricular ejection fraction, diastolic volume, mass, and wall motion score.
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
TL;DR: A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation developed in conjunction with the American College of Cardiology EchOCardiography Committee.
Journal ArticleDOI
Survival after the onset of congestive heart failure in Framingham Heart Study subjects.
TL;DR: Advances in the treatment of hypertension, myocardial ischemia, and valvular heart disease during the four decades of observation did not translate into appreciable improvements in overall survival after the onset of CHF in this large, unselected population.
Related Papers (5)
Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Alec Vahanian,Helmut Baumgartner,Jeroen J. Bax,Butchart Eg,Robert Dion,Gerasimos Filippatos,Frank A. Flachskampf,Roger Hall,Bernard Iung,Jarosław D. Kasprzak,Patrick Nataf,Pilar Tornos,Lucia Torracca,Arnold Wenink,Silvia G. Priori,Jean-Jacques Blanc,Andrzej Budaj,John Camm,Veronica Dean,Jaap W. Deckers,Kenneth Dickstein,John Lekakis,Keith McGregor,Marco Metra,João Morais,Ady Osterspey,Juan Tamargo,José Luis Zamorano,Annalisa Angelini,Manuel J. Antunes,Miguel Ángel García Fernández,Christa Gohlke-Baerwolf,Gilbert Habib,John J.V. McMurray,Catherine M Otto,Luc Pierard,José L. Pomar,Bernard Prendergast,Raphael Rosenhek,Miguel Sousa Uva +39 more