Extramitral Valvular Cardiac Involvement in Patients With Significant Secondary Mitral Regurgitation

Gurpreet K Singh,Farnaz Namazi,Kensuke Hirasawa,Pieter Van Der Bijl,Aniek L Van Wijngaarden,N Mai Vo,Gregg W Stone,Nina Ajmone Marsan,Victoria Delgado,Jeroen J Bax

doi:10.1016/j.amjcard.2021.09.022

Abstract

Patients with secondary mitral regurgitation (SMR) often have extramitral valve cardiac involvement, which can influence the prognosis. SMR can be defined according to groups of extramitral valve cardiac involvement. The prognostic implications of such groups in patients with moderate and severe SMR (significant SMR) are unknown. A total of 325 patients with significant SMR were classified according to the extent of cardiac involvement on echocardiography: left ventricular involvement (group 1), left atrial involvement (group 2), tricuspid valve and pulmonary artery vasculature involvement (group 3), or right ventricular involvement (group 4). The primary end point was all-cause mortality. The prevalence of each cardiac involvement group was 17% in group 1, 12% in group 2, 23% in group 3%, and 48% in group 4. Group 3 and group 4 were independently associated with all-cause mortality (hazard ratio 1.794, 95% confidence interval 1.067 to 3.015, p=0.027 and hazard ratio 1.857, 95% confidence interval 1.145 to 3.012, p=0.012, respectively). In conclusion, progressive extramitral valve cardiac involvement (group 3 and group 4) was independently associated with all-cause mortality in patients with significant SMR.

Highlights

Present study proposes an algorithm to divide patients with secondary mitral regurgitation (SMR) into groups based on their extramitral valve, cardiac involvement and evaluated its prognostic implications
Patients were classified into 4 groups of cardiac involvement, based on the presence of extramitral valvular cardiac involvement derived from the first echocardiogram performed with patients in a hemodynamic stable condition showing significant SMR (Figure 1): group 1: LV involvement (LV enddiastolic diameter ≥57 mm and/or LVEF 34 ml/m2 and/or history of atrial fibrillation); group 3: tricuspid valve or pulmonary artery vasculature involvement; group 4: right ventricular (RV) involvement
This study showed that progressive extramitral valvular cardiac involvement is independently associated with allcause mortality, a finding mainly driven by group 3 and group 4 (RV involvement)

Summary

With Significant Secondary Mitral Regurgitation

MDa, Farnaz Namazi, MDa, Kensuke Hirasawa, MD, PhDa, Pieter van der Bijl, MD, PhDa, Aniek L. van Wijngaarden, MDa, N. MDb,c, Nina Ajmone Marsan, MD, PhDa, Victoria Delgado, MD, PhDa, and Jeroen J. Cardiac classification algorithms have been applied to severe aortic stenosis and have shown that extra-aortic valve, cardiac involvement provides incremental prognostic value over measures of aortic stenosis severity.[10] the aDepartment of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; bThe Zena and Michael A. Present study proposes an algorithm to divide patients with SMR into groups based on their extramitral valve, cardiac involvement and evaluated its prognostic implications

Methods

Results

Discussion

Multivariable Analysis

Disclosures