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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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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Relationship between mitral leaflets angles, left ventricular geometry and mitral deformation indices in patients with ischemic mitral regurgitation: imaging by echocardiography and cardiac magnetic resonance.
Agata Leśniak-Sobelga,Ewa Wicher-Muniak,Magdalena Kostkiewicz,Maria Olszowska,Piotr Musialek,Piotr Klimeczek,Paweł Banyś,Mieczysław Pasowicz,Wiesława Tracz,Piotr Podolec +9 more
TL;DR: Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR, and indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR were correlated with echocardiography.
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Sreekanth Vemulapalli,Steven J. Lippmann,Mitchell W. Krucoff,Adrian F. Hernandez,Lesley H. Curtis,Elyse Foster,Atif Qasim,Andrew Wang,Donald D. Glower,Ted Feldman,Bradley G. Hammill +10 more
TL;DR: MitraClip was associated with a reduced rate of all‐cause and HF hospitalizations and an increased rate of bleeding hospitalizations, and one‐year Medicare costs were reduced in those who survived a full year after the MitraClipper procedure.
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Transcatheter Mitral Valve Replacement with Tendyne.
TL;DR: Transcatheter mitral valve replacement with the Tendyne prosthesis has shown potential at short-term follow-up to be an effective and safe treatment alternative for high-risk patients with severe mitral valves disease.
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ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Review of the 2017 Document for the Cardiac Anesthesiologist.
Pankaj Jain,Michael Fabbro +1 more
TL;DR: The present review focuses and elaborates on the key aspects relevant to the cardiac anesthesiologist in the peri-interventional setting.
Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Management of Patients With Valvular Heart Disease: A Report of the American College 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the
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