Prognostic Implications of Right Ventricular Dysfunction in Degenerative Mitral Regurgitation
Abstract
ABSTRACT Background The prevalence and impact of right ventricular dysfunction (RVD) in degenerative mitral regurgitation (DMR) is unknown. We aimed to determine whether RVD assessed by echocardiography in routine clinical practice is independently associated with survival in patients with DMR. Methods We used data from the Mitral Regurgitation International DAtabase-Quantitative (MIDA-Q) which included patients with isolated DMR due to mitral valve prolapse from January 2003 to January 2020 from 5 tertiary centers across North America, Europe, and the Middle East. A cohort of 4,379 (mean age: 67 years, 64.6% males, follow-up:5.3[3.3-8.2]years) consecutive patients with significant (≥moderate) DMR was included and long-term survival was analyzed. Results RVD, identified in 584(13.3%) patients, was associated with reduced 10-year survival (49±3% vs. 67±1%; p<0.001 ), overall and in all subgroups of patients, even after comprehensive adjustment including left ventricular dilatation and dysfunction, DMR severity, pulmonary pressures and surgery (adjusted HR[95%CI]=1.55[1.31-1.84]; p<0.001 ). This excess mortality was observed under medical management (adjusted HR[95%CI]=1.39[1.12-1.72]; p=0.003 ) and after surgical correction of mitral regurgitation (adjusted HR[95%CI]=1.56[1.08-2.27]; p=0.019 ). Patients with RVD undergoing surgery within 3 months of diagnosis experienced a better 10-year survival (73±4% vs. 38±4%; p<0.001 ), even after adjustment (adjusted HR[95%CI]=0.53[0.35-0.81]; p=0.003) despite an increase of 1-month post-operative mortality (5% vs 2.2% for patients without RVD; p<0.001 ). Conclusions RVD is observed in 13.3% of significant DMR and exhibits a powerful and independent association with excess mortality partially attenuated by mitral surgery. Therefore, assessment of right ventricular systolic function should be included in routine DMR evaluation and in the clinical decision-making process.
Authors 17
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Centre Hospitalier Universitaire Amiens-Picardie · Université de Picardie Jules Verne
Affiliation as printed
Department of Cardiology, Amiens University Hospital, Amiens, France
UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
Department of Cardiology, miens University Hospital, miens, France
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Affiliation as printed
Department of Echocardiography, Cardio X Clinic, Cannes, France
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
epartment of Echocardiography, Cardio X Clinic, Cannes, France
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Affiliation as printed
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
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Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
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Université de Nantes · Nantes Université
Affiliation as printed
University of Nantes, Department of Cardiology, Nantes, France
University of Nantes, Department of Cardiology, Nantes, rance
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Affiliation as printed
Tel Aviv Medical Center and Sackler Faculty of Medicine, Department of Cardiology, Tel Aviv, Israel
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Affiliation as printed
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
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Centre Hospitalier Universitaire Amiens-Picardie · Université de Picardie Jules Verne
Affiliation as printed
Department of Cardiology, Amiens University Hospital, Amiens, France
UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
Department of Cardiology, miens University Hospital, miens, France
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Affiliation as printed
University Campus Bio-Medico, Department of Cardiology, Rome, Italy
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Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
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Affiliation as printed
Tel Aviv Medical Center and Sackler Faculty of Medicine, Department of Cardiology, Tel Aviv, Israel
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Université de Nantes · Nantes Université
Affiliation as printed
University of Nantes, Department of Cardiology, Nantes, France
University of Nantes, Department of Cardiology, Nantes, rance
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Affiliation as printed
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
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Affiliation as printed
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
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Maurice L. Enriquez-Sarano corresponding
Abbott Northwestern Hospital · Mayo Clinic
Affiliation as printed
Abbott Northwestern Hospital, Minneapolis. Minnesota
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
Division of ardiovascular Diseases, Mayo linic, Rochester, MN, USA
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Christophe Michel Tribouilloy corresponding
Centre Hospitalier Universitaire Amiens-Picardie · Université de Picardie Jules Verne
Affiliation as printed
Department of Cardiology, Amiens University Hospital, Amiens, France
UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
Department of Cardiology, miens University Hospital, miens, France
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