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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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
Three-Dimensional Ultrasound Imaging Model of Mitral Valve Regurgitation: Design and Evaluation
Stephen H. Little,Stephen R. Igo,Marti L. McCulloch,Craig J. Hartley,Yukihiko Nosé,William A. Zoghbi +5 more
TL;DR: The model was designed to optimize Doppler signal quality while reflecting anatomic structural relationships and flow events and can be easily adapted to mimic other intracardiac flow pathology or assess future Dopplers applications.
Journal ArticleDOI
Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction.
Alessandra Meris,Maria Amigoni,Anil Verma,Jens Jakob Thune,Lars Køber,Eric J. Velazquez,John J.V. McMurray,Marc A. Pfeffer,Robert M. Califf,Robert A. Levine,Scott D. Solomon +10 more
TL;DR: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI.
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Guía de práctica clínica sobre el tratamiento de las valvulopatías
Alec Vahanian,Helmut Baumgartner,Jeroen J. Bax,Eric G. Butchart,Robert Dion,Gerasimos Filippatos,Frank A. Flachskampf,Roger Hall,Bernard Iung,Jarosław D. Kasprzak,Patrick Nataf,Pilar Tornos,Lucia Torracca,Arnold Wenink +13 more
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Mitral Annular Disjunction: The Forgotten Component of Myxomatous Mitral Valve Disease.
Journal ArticleDOI
Vena contracta area for severity grading in functional and degenerative mitral regurgitation: a transoesophageal 3D colour Doppler analysis in 500 patients.
Björn Goebel,Roland Heck,Ali Hamadanchi,Sylvia Otto,Torsten Doenst,Christian Jung,Alexander Lauten,Hans R. Figulla,P. Christian Schulze,Tudor C. Poerner +9 more
TL;DR: VCA3D is a robust parameter for quantification of MR, showing a good correlation with the reference method using 3D datasets of LV, and prediction of severe MR.
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