Prognostic Implications of Right Ventricular Dysfunction in Severe Degenerative Mitral Regurgitation
Journal of the American Heart Association, vol. 14, pp. e036206
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 mortality in patients with DMR. Methods and Results We used data from the MIDA‐Q (Mitral Regurgitation International DAtabase‐Quantitative) registry, 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 2917 (mean age: 66 years, 70.8% male patients, follow‐up: 5.2 [3.3–8.3] years) consecutive patients with severe DMR was included and long‐term mortality was analyzed. RVD, identified in 426 (14.6%) patients, was associated with reduced 8‐year survival (55%±3% versus 77%±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 hazard ratio, 1.44 [95% CI, 1.17–1.77]; P <0.001). This excess mortality was observed under medical management (adjusted hazard ratio, 1.57 [95% CI, 1.20–2.05]; P =0.001) and after surgical correction of mitral regurgitation (adjusted hazard ratio, 1.45 [95% CI, 1.02–2.05]; P =0.039). Patients with RVD undergoing surgery within 3 months of diagnosis experienced a better 8‐year survival (73%±4% versus 43%±4%; P <0.001), even after adjustment (adjusted hazard ratio, 0.44 [95% CI, 0.29–0.67]; P <0.001) despite an increase of 1‐month postoperative mortality (7.1% versus 0.5% for patients without RVD; P <0.001). Conclusions RVD is observed in 14.6% of severe 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 18
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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
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Mayo Clinic · Centre Hospitalier de Cannes
Affiliation as printed
Department of Echocardiography Cardio X Clinic Cannes France
Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
Division of Echocardiography, Cardio X Clinic, Cannes, France (France)
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Affiliation as printed
Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
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Jeroen Joost Bax Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden The Netherlands
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Centre Hospitalier Universitaire de Nantes · Université de Nantes · Nantes Université
Affiliation as printed
Department of Cardiology University of Nantes Nantes France
CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (1 Place Alexis-Ricordeau, 44000 Nantes - France)
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Affiliation as printed
Department of Cardiology Tel Aviv Medical Center and Sackler Faculty of Medicine Tel Aviv Israel
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Affiliation as printed
Division of Cardiovascular Diseases Mayo Clinic 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
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Università Campus Bio-Medico · Campus Bio Medico University Hospital
Affiliation as printed
Department of Cardiology University Campus Bio‐Medico Rome Italy
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Nina Ajmone Marsan Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden The Netherlands
LUMC - Leiden University Medical Center (Leids Universitair Medisch Centrum, Universiteit Leiden - 1233 ZA, Leiden - Pays-Bas)
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Aniek L. van Wijngaarden Aachen Department of Cardiology Leiden University Medical Center Leiden The Netherlands
Leiden University Medical Center
Affiliation as printed
Department of Cardiology Leiden University Medical Center Leiden The Netherlands
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Affiliation as printed
Department of Cardiology Tel Aviv Medical Center and Sackler Faculty of Medicine Tel Aviv Israel
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Centre Hospitalier Universitaire de Nantes · Université de Nantes · Nantes Université
Affiliation as printed
Department of Cardiology University of Nantes Nantes France
CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (1 Place Alexis-Ricordeau, 44000 Nantes - France)
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Centre Hospitalier Universitaire Amiens-Picardie
Affiliation as printed
Department of Clinical Research Amiens University Hospital Amiens France
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Affiliation as printed
Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
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Affiliation as printed
Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
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Maurice L. Enriquez-Sarano corresponding
Abbott Northwestern Hospital · Mayo Clinic
Affiliation as printed
Abbott Northwestern Hospital Minneapolis MN USA
Division of Cardiovascular Diseases Mayo Clinic 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
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