Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction

Abstract

Background Natural history of atrial and ventricular secondary mitral regurgitation (SMR) is poorly understood. We compared the impact of the degree of SMR on survival between atrial and ventricular dysfunction. Methods We conducted a retrospective cohort study of patients who underwent echocardiography in a healthcare network between 2013–2018. We compared the survival of patients with atrial and ventricular dysfunction, using propensity scores developed from differences in patient demographics and comorbidities within SMR severity strata (none, mild, moderate or severe). We fitted Cox proportional hazards models to estimate the risk-adjusted hazards of death across different severities of SMR between patients with atrial and ventricular dysfunction. Results Of 11,987 patients included (median age 69 years [IQR 58–80]; 46% women), 6,254 (52%) had isolated atrial dysfunction, and 5,733 (48%) had ventricular dysfunction. 3,522 patients were matched from each arm using coarsened exact matching. Hazard of death in atrial dysfunction without SMR was comparable to ventricular dysfunction without SMR (HR 1.1, 95% CI 0.9–1.3). Using ventricular dysfunction without SMR as reference, hazards of death remained higher in ventricular dysfunction than in atrial dysfunction across increasing severities of SMR: mild SMR (HR 2.1, 95% CI 1.8–2.4 in ventricular dysfunction versus HR 1.7, 95%CI 1.5–2.0 in atrial dysfunction) and moderate/severe SMR (HR 2.8, 95%CI 2.4–3.4 versus HR 2.4, 95%CI 2.0–2.9). Conclusions SMR across all severities were associated with better survival in atrial dysfunction than in ventricular dysfunction, though the magnitude of the diminishing survival were similar between atrial and ventricular dysfunction in increasing severity of SMRs.

The high-risk features among patients undergoing mitral valve operation for ischemic mitral regurgitation: The 3-strike score

“…Moderate or severe MR is found in 2.3% of older adults, 19 of whom approximately two-thirds have functional MR. 1 Among those with functional MR, 60% are of ischemic etiology. 1 , 20 This already high number of patients with severe iMR seeking treatment is likely to further increase with the recent Food and Drug Administration approval of the MitraClip for severe secondary MR, 21 similar to the impact of the adoption of transcatheter aortic valve replacement and its “halo” effect on surgical aortic valve replacement volume. 22 In multidisciplinary evaluation, the practical use of our risk stratification algorithm may be as the first broad-stroke identification of the low-risk group, which is expected to do very well from surgery, and separating them from the high-risk group, which likely would have poor surgical outcomes.…”

Contemporary Surgical Treatment for Functional Mitral Regurgitation

“…Recently, Mori et al suggested differences in outcomes between these two conditions, with A-FMR often associated with a relatively better prognosis. 43) Surgical interventions still have played a crucial role in the treatment of both V-FMR and A-FMR. The nuances in surgical outcomes underscore the necessity of distinguishing between V-FMR and A-FMR in clinical practice.…”