Author + information
The optimal therapy for functional mitral regurgitation (FMR) is not wellb established. Our goal was to define predictors of death, length of stay (LOS), and re-hospitalization in an elderly cohort (age>70) of high risk patients with FMR, and to assess if optimal medical therapy (OMT) had an impact on outcomes.
This was a retrospective review which identified 148 patients with FMR in a clinical database. The predictors we assed included FMR severity, heart failure, OMT, liver failure, Chronic Obstructive Pulmonary Disease (COPD), patent bypass graft, peripheral/cerebral vascular disease, dialysis, discharge age, left ventricular ejection fraction (LVEF), and creatinine.
COPD was the main independent predictor of death at one year (OR 5.11[95%CI 1.9-13.6] p=0.001). Adjusting for all other variables, the increased LOS was 0.5 +0.2 days for patients with moderate-severe FMR (p=0.023). Independent predictors of re-hospitalization included liver failure, peripheral vascular disease, dialysis, and discharge age. OMT did not have an impact on reducing mortality, LOS, or re-hospitalizations.
|Mean Age at Discharge from Index Hospitalization (Years)||78 +5.63|
|Male Gender (%)||55%|
|LOS From Index Admission (Days)||3.5 + 4.27|
|Death Within 1 Year of Discharge For Index Admission (%)||18%|
|Death Within 1 Year with Mild FMR (0–1) (%)||2.7%|
|Death Within 1 Year with Moderate-Severe FMR (2–4) (%)||21%, **p=0.04|
|Patients under OMT* (%)||54%|
|MeanLVEF(%)||35 +15 %|
|FMR Grade (0–4)|
|NYHA*** Class (1–4)|
|Liver Failure (%)||6%|
|Mean Creatinine (mg/dL)||1.4 + 0.9|
|Peripheral Vascular Disease (%)||25%|
|History of Myocardial Infarction (%)||12%|
|History of Coronary Artery Bypass Grafting (CABG) (%)||11%|
|History of CABG with at least one occluded graft (%)||83%|
|History of Atrial Fibrillation (%)||63%|
|History of Stroke (%)||3%|
Patients with moderate-severe FMR had increased mortality at one year.
OMT did not have a significant impact on overall outcomes. Severe FMR was a significant predictor for increased LOS. Our results indicate that the patients at highest risk are those with COPD and can help risk stratify patients who could benefit from invasive strategies to treat FMR.
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Mitral Regurgitation: Mechanisms and Treatment Options
Abstract Category: 10. Valvular Heart Disease: Clinical
Presentation Number: 1148-190
- 2012 American College of Cardiology Foundation