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0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation.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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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
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease
Rick A. Nishimura,Catherine M Otto,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Robert A. Guyton,Patrick T. O'Gara,Carlos E. Ruiz,Nikolaos J. Skubas,Paul Sorajja,Thoralf M. Sundt,James D. Thomas +11 more
TL;DR: The medical profession should play a central role in evaluating evidence related to drugs, devices, and procedures for detection, management, and prevention of disease.
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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
TL;DR: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure.
Journal ArticleDOI
Guidelines on the management of valvular heart disease (version 2012)
Alec Vahanian,Ottavio Alfieri,Felicita Andreotti,Manuel J. Antunes,Gonzalo Barón-Esquivias,Helmut Baumgartner,Michael A. Borger,Thierry Carrel,Michele De Bonis,Arturo Evangelista,Volkmar Falk,Bernard Iung,Patrizio Lancellotti,Luc Pierard,Susanna Price,Hans-Joachim Schäfers,Gerhard Schuler,Janina Stępińska,Karl Swedberg,Johanna J.M. Takkenberg,Ulrich O. von Oppell,Stephan Windecker,José Luis Zamorano,Marian Zembala +23 more
TL;DR: Guidelines summarize and evaluate all evidence available on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome.
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2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Rick A. Nishimura,Catherine M Otto,Robert O. Bonow,Blase A. Carabello,John P. Erwin,Lee A. Fleisher,Hani Jneid,Michael J. Mack,Christopher J. McLeod,Patrick T. O'Gara,Vera H. Rigolin,Thoralf M. Sundt,Annemarie Thompson +12 more
TL;DR: In this article, Levine and O'Gara proposed a new chairperson for FAHA, who was elected by a majority of the FAHA board members, including Birtcher, Bozkurt and Halperin.
References
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Journal ArticleDOI
Mitral regurgitation: clinical patterns, pathophysiology and natural history.
Arthur Selzer,Fumiji Katayama +1 more
Journal ArticleDOI
Mitral Regurgitation: A New Clinical Perspective
Maurice Enriquez-Sarano,Thomas A. Orszulak,Hartzell V. Schaff,Martin D. Abel,A. Jamil Tajik,Robert L. Frye +5 more
TL;DR: It is suggested that early surgical correction (before occurrence of overt symptoms or left ventricular dysfunction) should be considered when patients are diagnosed with severe mitral regurgitation.
Journal ArticleDOI
Repairing the Mitral Valve
TL;DR: An elegant and detailed multivariate analysis concludes that mitral valve repair is an independent predictor of improved operative long-term mortality, ejection fraction, and functional result.
Journal ArticleDOI
Left ventricular energy in mitral regulation: a preliminary report
TL;DR: Energy exchange based on Newtonian principles is the most appropriate way to express the function of any pump--including the heart, and colour flow mapping which detects only KE of turbulent jet flow must underestimate LV energy loss and, because of patient to patient variation, cannot consistently reflect severity of regurgitation.
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