Abstract
Introduction: The purpose of this study was to assess symptoms in patients undergoing class I/IIa ACC/AHA guideline directed lone mitral valve surgery. Hypothesis: Symptoms in patients undergoing guideline directed mitral valve surgery and are not associated with the severity of mitral regurgitation (MR). Methods: In this prospective multicenter study, 93 patients with a Class I/IIa indication for isolated mitral valve surgery were evaluated. Each patient had a cardiovascular magnetic resonance (CMR) exam prior to surgery and 3 to 5 months following surgery. The presence or absence of symptoms was determined by the treating physician. Symptoms were quantified using the Kansas City Cardiomyopathy Questionaire (KCCQ). Results: There were 55 (59%) patients who were symptomatic preoperatively. Based on CMR regurgitant volume, 30%, 39%, and 31% had mild, moderate, or severe MR, respectively. Among those with mild, moderate, and severe MR, the percentage of patients who were symptomatic at baseline did not differ significantly and the severity of symptoms as quantified by the KCCQ did not differ significantly (Figure1A). Post-surgical improvement in the percentage of patients with symptoms and the KCCQ score did not differ based on baseline MR severity (Figure1B). Patients who were symptomatic before surgery reported the greatest improvement in KCCQ symptom score following surgery compared to those who were asymptomatic at baseline (17 ± 25 vs. -0.4 ± 17, p<0.001). Conclusions: In a multi-center study of patients undergoing ACC/AHA class I/IIa indication for surgery for MR there was no of correlation between MR severity and symptoms. These findings question the assumptions that severity of MR is associated with worse symptoms prior to surgery and those with severe MR benefit the most from mitral valve surgery. The lack of correlation between MR severity, symptoms, and outcomes is concerning and it suggests symptoms may be often misattributed to MR.
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