Author + information
- Clémence Antoine. Giovanni Benfari,
- Hector Michelena,
- Joseph F. Maalouf,
- Vuyisile Nkomo and
- Maurice Enriquez-Sarano
Background: Quantitation of mitral regurgitation (MR) was validated in pilot cohorts of limited size with heterogeneous MR causes and using measurements by selected few operators. Doubts were raised regarding methods’ reliability and generalizability of pilot results. Hence, applicability and thresholds of effective regurgitant orifice (ERO) in routine practice in homogeneous degenerative mitral valve disease (DMVD) is uncertain.
Methods: We included patients diagnosed in routine practice with DMVD in 2003-2011 with MR quantification by any Mayo accredited echocardiographer without other valvular, myocardial or pericardial disease.
Results: Among 3914 patients (age 62±17 years, 55% male, ejection fraction 63±8%) 32% had no MR, and ERO was 1-20mm2 in 19%, 21-40 in 24%, 41-60 in 16% and >60mm2 in 9%. After adjustment by age, sex, comorbidities and all classic prognosis factors of DMVD, routine ERO independently predicted excess mortality under medical treatment (hazard ratio 1.19[1.31-1.24] per 10mm2, p<0.0001). Routine ERO prognostic impact existed along MR entire severity span, starting around 20 mm2 and beyond the 40mm2 threshold (figure).
Conclusions: ERO measured in routine clinical practice by multiple practitioners, in consecutive unselected DMVD, is independently predictive of excess mortality after diagnosis. Thus, despite all doubts and concerns, MR quantitation provides considerable prognostic value in routine clinical practice and remains a cornerstone of MR assessment.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Valvular Heart Disease: Mitral Valve Disease
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1145-026
- 2017 American College of Cardiology Foundation