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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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
Outcome of Watchful Waiting in Asymptomatic Severe Mitral Regurgitation
Raphael Rosenhek,Florian Rader,Ursula Klaar,Harald Gabriel,Marcel Krejc,Daniel Kalbeck,Michael Schemper,Gerald Maurer,Helmut Baumgartner +8 more
TL;DR: Asymptomatic patients with severe degenerative mitral regurgitation can be safely followed up until either symptoms occur or currently recommended cutoff values for LV size, LV function, or pulmonary hypertension are reached.
Journal ArticleDOI
Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Database
James S. Gammie,Shubin Sheng,Bartley P. Griffith,Eric D. Peterson,J. Scott Rankin,Sean M. O'Brien,James M. Brown +6 more
TL;DR: This study documents several important trends in MV surgery, including the progressive adoption of mitral valve repair and increasing use of bioprosthetic replacement valves.
Journal ArticleDOI
Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy
Andrea Rossi,Frank Lloyd Dini,Pompilio Faggiano,Eustachio Agricola,Mariantonietta Cicoira,Silvia Frattini,Anca Simioniuc,Mariangela Gullace,Stefano Ghio,Maurice Enriquez-Sarano,Pier Luigi Temporelli +10 more
TL;DR: In a large patient population it was shown that a quantitatively defined FMR was strongly associated with the outcome of patients with HF, independently of LV function.
Journal ArticleDOI
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary
Catherine M Otto,Rick A. Nishimura,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Federico Gentile,Hani Jneid,Eric V. Krieger,Michael Mack,Christopher J. McLeod,Patrick T. O'Gara,Vera H. Rigolin,Thoralf M. Sundt,Annemarie Thompson,Christopher Toly +14 more
TL;DR: The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
Journal ArticleDOI
Minimally invasive mitral valve surgery: a systematic review and meta-analysis
TL;DR: Current clinical data suggest that minimally invasive mitral valve surgery is a safe and a durable alternative to a conventional approach and is associated with less morbidity.
References
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Journal ArticleDOI
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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
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Survival after the onset of congestive heart failure in Framingham Heart Study subjects.
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