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Pulmonary Hypertension and Long-term Mortality in Aortic and Mitral Regurgitation

2010; Elsevier BV; Volume: 123; Issue: 11 Linguagem: Inglês

10.1016/j.amjmed.2010.06.018

1555-7162

Matthew W. Parker, Murray A. Mittleman, Carol A. Waksmonski, Greg Sanders, Marilyn F. Riley, Pamela S. Douglas, Warren J. Manning,

Cardiac Structural Anomalies and Repair

Outcomes data in patients with aortic regurgitation or mitral regurgitation have been limited to small series with generally 40 mm Hg). Age-stratified Cox proportional hazards models compared survival among groups and adjusted for sex, depressed left ventricular ejection fraction, and pulmonary artery systolic pressure. Mortality data were obtained from the 2008 Social Security Death Index.Of 4984 echocardiograms performed in 4050 patients, 1156 patients (28%; aged 72±14 years) had at least mild aortic regurgitation and 1971 patients (49%; aged 69±16 years) had at least mild mitral regurgitation. Overall 15-year mortality in patients with aortic regurgitation was 74% and similar for all grades of aortic regurgitation. Overall 15-year mortality in patients with mitral regurgitation was 71% and got progressively worse with increasing severity grade of mitral regurgitation (63% for mild to 81% for at least moderate-to-severe). For both aortic and mitral regurgitation, moderate or greater pulmonary artery systolic hypertension was associated with increased mortality (in patients with aortic regurgitation, hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.58-2.41, and in mitral regurgitation patients, HR, 1.48; 95% CI, 1.26-1.75).Long-term (15-year) survival of patients with aortic regurgitation is poor and is independent of regurgitation severity. In contrast, long-term survival of patients with mitral regurgitation correlates with regurgitation severity. For both groups, moderate or greater pulmonary artery systolic hypertension identified those at highest risk.