Abstract
Despite improvement in diagnosis and management, Mitral regurgitation (MR) remains associated with high morbidity, serious complications. Therefore we decided to focus on elderly population with mitral regurgitation and renal dysfunction. Clinical characteristics and assess renal dysfunction, impact on mortality and determine risk factors associated to poor prognosis. Prospective study, including patients with more 65 years and renal function defined by levels of serum creatinine and GFR calculated by CKD-Epi method in initial consultation. We divide 2 groups with MR in elderly G1 with good GFR > 60 mL/min/m 2 and G2 < 60 mL/min/m 2 , we excluded patients with MR in shock or with acute renal injury due to other cause. Fifty-eight patients were included. The average age is 74 ± 6.4 years, sex ratio was 0.48, and predominant CV risk factor were diabetes mellitus, hypertension and smoking. Dyspnea II, III, IV NYHA respectively was 22.4%, 69% and 8.6%, correlated with MR severity ( P = 0.028), Angina was present in 5.2%, and palpitation in 10%. AF was observed in 15% cases. Mean serum creatinine 1.00 ± 0.46 mg/dL, and median GFR was 81 mL/min/m 2 . MR was isolated in 34 cases, main mecanism was rhumatismal in 29.3%, severe MR was observed in 20.7%, HFrEF, HFmEF in 7 and 14 cases respectively, with mean SGL at −16.6 ± 4, LV and LA dilatation observed in 31 and 42 patients respectively with no signification between 2 groups. LA volume was correlated with renal dysfunction 51 ± 12 mL/m 2 in G2, and 42 mL/m 2 in G1 patients P = 0.01 OR 1.2, [1.05–1.3]. PAH in MR was present in 50% in G1 versus 38% in G2 ( P = 0.08). A follow-up in 6 months showed aggravation of MR grade in 3.4% in G1 and 8.6% in G2 ( P = 0.06) and at 12 months 5.2% in G1 and 17.2% in G2 ( P = 0.025). 4 patients who died during follow-up in G2 despite optimal medical treatment. Lower GFR was significantly correlated to MR grade progression, and an independent mortality prognostic factor.
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