Author + information
- Kenya Kusunose,
- Nancy Obuchowski,
- Zoran Popovic,
- Milind Desai,
- Scott Flamm,
- Brian Griffin and
- Deborah Kwon
Ischemic mitral regurgitation (IMR) is associated with substantial risk of death. While surgical mitral valve intervention (MVi) may improve symptoms, it has not been shown to improve survival. The aim of this study was to identify predictors of adverse outcomes in IMR patients with MVi.
Consecutive ischemic cardiomyopathy (ICM) patients who underwent MVi were included. Cardiac magnetic resonance (CMR) was used to assess left ventricular remodeling and myocardial scarring. The effective regurgitant orifice area (EROA) was calculated from the proximal isovelocity surface area by echocardiography.
We evaluated 117 patients (age 65±10 years) during follow-up (median:62 months). On multivariable analysis, age (p=0.013), diabetes (p=0.001), dyslipidemia (p=0.012), papillary muscle scar (p=0.010), incomplete revascularization (p=0.001), and an interaction with total scar% and EROA <0.20 cm2 (p=0.005) were each independently associated with a increased risk. Among patients with EROA <0.20 cm2 the hazard ratio is 3.3 for every 10% increase in total scar. In contrast, for every 10% increase in total scar, the hazard ratio is 9.0 (expected risk is 21.8) in patients with higher EROA (Figure).
Higher EROA, in the setting of increased myocardial scar burden, is associated with significantly higher risk of mortality in patients with advanced ICM undergoing MVi. Patients with IMR and Scar>25%, should be strongly considered for more aggressive therapeutic options.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Area, South Hall A1
Monday, April 04, 2016, 1:15 p.m.-1:25 p.m.
Session Title: Mitral Regurgitation: New Information and Options
Abstract Category: 40. Valvular Heart Disease: Clinical
Presentation Number: 1284M-07
- 2016 American College of Cardiology Foundation