Abstract 15863: Impact of Right and Left Ventricular Dysfunction on Mortality in Secondary Mitral Regurgitation Patients Without Surgical and Interventional Treatment

Abstract

Introduction: Secondary mitral regurgitation (SMR) is related with poor clinical outcome. Impact of right ventricular (RV) dysfunction with or without left ventricular (LV) dysfunction in SMR patients remains unclear. Hypothesis: This study aimed to investigate the prevalence of isolated LV, RV, and biventricular dysfunction, and to determine their prognostic implication in moderate-to-severe SMR without surgical and interventional treatment. Methods: A total of 1090 consecutive moderate-to-severe SMR patients without surgical and interventional treatment hospitalized in our hospital center between 2009 and 2018 (aged 75±12years, 60.4% male) were included. Clinical and echocardiographic characteristics were analyzed. All patients completed at least 1-year clinical follow-up. The primary endpoint was defined as all-cause death. Results: Mean left ventricular ejection fraction (LVEF) was 44.6±16.2%, and 59.3% of patients had LVEF <50% (defined as LV dysfunction). RV dysfunction was defined as a reduced tricuspid annular plane excursion (TAPSE<17mm) or an increased systolic pulmonary artery disease (sPAP>40mmHg). All-cause mortality was 47.8% [follow-up period: median 23 (8-40) months]. Patients were divided into 4 subgroups: 1) preserved biventricular function: n=136 (12.5%); 2) isolated LV dysfunction: n=97 (8.9%); 3) isolated RV dysfunction: n=308 (28.3%); 4) biventricular dysfunction: n=549 (50.4%). The mortality in above groups was 27.2%, 36.1%, 50.0% and 53.7%, respectively. Multivariable survival analysis showed that isolated LV dysfunction, isolated RV dysfunction, or biventricular dysfunction were all independently associated with increased all-cause mortality, after adjustment for age, sex and other clinical covariates associated with mortality. Conclusions: Compared to patients with preserved biventricular function or isolated LV dysfunction, RV and biventricular dysfunction are associated with significantly higher all-cause mortality in SMR patients without surgical/interventional treatment. This might constitute important implications for planning and timing of therapy.