Prognostic implications of right ventricular dysfunction in degenerative mitral regurgitation

European Heart Journal, vol. 45

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.determinant ans prognosis of RVD in MR

Authors 14

1. Yohann Bohbot

   Centre Hospitalier Universitaire Amiens-Picardie

   Affiliation as printed

   University Hospital of Amiens , Amiens ,

2. Benjamin A Essayagh

   Mayo Clinic

   Affiliation as printed

   Mayo Clinic , Rochester ,

   Mayo Clinic [Rochester] (200 First St. SW Rochester, MN 55905 - United States)

3. Giovanni Benfari

   Mayo Clinic

   Affiliation as printed

   Mayo Clinic , Rochester ,

   Mayo Clinic [Rochester] (200 First St. SW Rochester, MN 55905 - United States)

4. Jeroen Joost Bax Aachen

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Leiden University , Leiden ,

   LUMC - Leiden University Medical Center (Leids Universitair Medisch Centrum, Universiteit Leiden - 1233 ZA, Leiden - Netherlands)

5. Thierry Le Tourneau

   Inserm · Institut du Thorax

   Affiliation as printed

   Institut du Thorax, Inserm UMR 1087 , Nantes ,

6. Dan Ruşinaru

   Centre Hospitalier Universitaire Amiens-Picardie

   Affiliation as printed

   University Hospital of Amiens , Amiens ,

7. Nina Ajmone Marsan Aachen

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Leiden University , Leiden ,

   LUMC - Leiden University Medical Center (Leids Universitair Medisch Centrum, Universiteit Leiden - 1233 ZA, Leiden - Netherlands)

8. Aniek Van Wijngaarden Aachen

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Leiden University , Leiden ,

   LUMC - Leiden University Medical Center (Leids Universitair Medisch Centrum, Universiteit Leiden - 1233 ZA, Leiden - Netherlands)

9. Aviram Hochstadt

   Tel Aviv Sourasky Medical Center

   Affiliation as printed

   Tel Aviv Sourasky Medical Center , Tel Aviv ,

   Tel Aviv Sourasky Medical Center [Tel Aviv] (Weizmann St 6, Tel Aviv-Yafo - Israel)

10. J.C. Roussel

    Inserm · Institut du Thorax

    Affiliation as printed

    Institut du Thorax, Inserm UMR 1087 , Nantes ,

11. Prabin Bikram Thapa

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic , Rochester ,

    Mayo Clinic [Rochester] (200 First St. SW Rochester, MN 55905 - United States)

12. Héctor I. Michelena

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic , Rochester ,

    Mayo Clinic [Rochester] (200 First St. SW Rochester, MN 55905 - United States)

13. Maurice L. Enriquez-Sarano

    Mayo Clinic

    Affiliation as printed

    Mayo Clinic , Rochester ,

    Mayo Clinic [Rochester] (200 First St. SW Rochester, MN 55905 - United States)

14. Christophe Michel Tribouilloy

    Centre Hospitalier Universitaire Amiens-Picardie

    Affiliation as printed

    University Hospital of Amiens , Amiens ,