The MIDA quantitative mortality risk score: prognostic model in floppy mitral valves

European Heart Journal, vol. 42

Abstract

Abstract Background The Mitral Regurgitation International Database (MIDA) score is a validated tool for Degenerative Mitral Regurgitation (DMR) management, being able to position a given patient within a continuous spectrum of short and long term mortality. However, whether this score may be applicable and incremental in the entire span of Floppy Mitral Valves (FMV), regardless of DMR severity, remains unsubstantiated. Methods The MIDA-Quantitative (MIDA-Q) unprecedented registries include 8187 consecutive patients (age 64±17 years, 45% women, follow-up 5.5±3.4 years) with isolated degenerative mitral valve disease diagnosed at tertiary (European/ North-American/ Middle Eastern) centers in whom DMR severity used both integrative and quantitative grading. The MIDA-Q Score ranged from 0 to 15 depending on accumulating risk factors. Long-term survival overall, under medical management and post-mitral surgery was analysed. Results By quantitative grading, MR was no/trivial in 1938 (24%), mild in 1423 (17%), moderate in 2027 (25%) and severe in 2799 (34%), with ERO 0.24±24cm2, RVol 37±35mL, and posterior leaflet prolapse in 49%. MIDA-Q Scores stratified in 8 categories were 0 (score 0, n=851), 1 (score 1–2, n=1301), 2 (score 3–4, n=2043), 3 (score 5–6, n=1581), 4 (score 7–8, n=1273), 5 (score 9–10, n=718), 6 (score 11–12, n=331) and 7 (score 13–15, n=89). In the whole MIDA-Q population (n=8187 patients), 5-year survival under medical management with Scores categories 0–1, 2–4, and 5–7 was 96±1%, 73±1%, and 61±3% respectively (P<0.0001). Five-year mortality ranged from 3% with MIDA Q-score 0 to 95% with MIDA Q-score 13–15 (P<0.0001). After mitral surgery, 1-year mortality with Scores categories 0–1, 2–4, and 5–7 was 0%, 1%, and 6% respectively and 5-year post-operative survival was 99±1%, 94±1%, and 82±2% (all P<0.0001). In models including age, sex and all guideline-provided prognostic markers, the EuroScoreII and the MIDA Score without DMR severity, the MIDA-Q Score provided incremental prognostic information (P<0.001). Conclusion This unheard international cohort of patients with FMV and prospective mitral severity quantitative grading, enables for the first time the calculation of a MIDA-Q Score, highly determinant of survival after diagnosis of FMV with any degree of DMR, that may be very useful for mitral valve prolapse management. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Mayo Fundation Figure 1

Authors 14

1. Benjamin A Essayagh

   Mayo Clinic

   Affiliation as printed

   Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America

2. Giovanni Benfari

   Mayo Clinic

   Affiliation as printed

   Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America

3. Clémence Antoine

   Mayo Clinic

   Affiliation as printed

   Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America

4. Francesco Grigioni

   Università Campus Bio-Medico · Campus Bio Medico University Hospital

   Affiliation as printed

   Campus Bio-Medico University of Rome, Department of Cardiology, Rome, Italy

5. Thierry Le Tourneau

   Centre Hospitalier Universitaire de Nantes

   Affiliation as printed

   University Hospital of Nantes, Department of Cardiology, Nantes, France

6. J.C. Roussel

   Centre Hospitalier Universitaire de Nantes

   Affiliation as printed

   University Hospital of Nantes, Department of Cardiothoracic Surgery, Nantes, France

7. Jeroen Joost Bax Aachen Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)

8. Victoria Delgado Aachen Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)

9. Nina Ajmone Aachen Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)

10. Aniek Van Wijngaarden Aachen Department Of Cardiology, Leiden

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)

11. Christophe Michel Tribouilloy

    Centre Hospitalier Universitaire Amiens-Picardie

    Affiliation as printed

    University Hospital of Amiens, Department of Cardiology, Amiens, France

12. Aviram Hochstadt

    Tel Aviv University

    Affiliation as printed

    Tel Aviv University, Department of Cardiology, Tel Aviv, Israel

13. Héctor I. Michelena

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America

14. Maurice L. Enriquez-Sarano

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America