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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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
Citations
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Progress in mitral valve disease: understanding the revolution.
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Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography
Sebastian Militaru,Odile Bonnefous,Karima Hami,Hélène Langet,Laura Houard,Stephane Allaire,Anne-Catherine Pouleur,Scott William Dianis,Alexandre This,Christophe Beauloye,David Vancraeynest,Agnes Pasquet,Jean-Louis Vanoverschelde,Bernhard Gerber +13 more
TL;DR: Three-dimensional MR flow quantification had high accuracy for diagnosing severe MR using TEE and showed better agreement with CMR than 2D PISA TTE or TEE, suggesting that this method is more accurate than conventional two-dimensional PISA transthoracic echocardiography and TEE.
Journal ArticleDOI
Association of transcatheter edge-to-edge repair with improved survival in older patients with severe, symptomatic degenerative mitral regurgitation.
Giovanni Benfari,Paul Sorajja,Giovanni Pedrazzini,Maurizio Taramasso,Mara Gavazzoni,Luigi Biasco,Benjamin Essayagh,Francesco Grigioni,Richard Bae,Christophe Tribouilloy,Jean-Louis Vanoverschelde,Hector I. Michelena,Vinayak Bapat,David Vancraynest,Catherine Klersy,Moreno Curti,Prabin Thapa,Maurice Enriquez-Sarano +17 more
TL;DR: Amongst older patients with severe symptomatic DMR at high surgical risk, mitral TEER was associated with higher survival vs. unoperated patients, which should be actively considered in patients deemed inoperable.
Journal ArticleDOI
Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation.
Sanjiv Sharma,Joel Lardizabal,Mark Monterroso,Neil Bhambi,Rohan Sharma,Rasham Sandhu,Satinder Singh +6 more
TL;DR: Clinically unrecognized moderate MR is prevalent in "lone" AF -either as an etiologic factor leading to "l single" AF or developing after onset of AF.
Journal ArticleDOI
Pulmonary Hypertension and Long-term Mortality in Aortic and Mitral Regurgitation
Matthew W. Parker,Murray A. Mittleman,Carol A. Waksmonski,Greg Sanders,Marilyn F. Riley,Pamela S. Douglas,Warren J. Manning +6 more
TL;DR: For both aortic and mitral regurgitation, moderate or greater pulmonary artery systolic hypertension was associated with increased mortality, and long-term survival of patients with mitral Regurgitation is poor and is independent ofregurgitation severity.
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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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