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Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets

2009; Elsevier BV; Volume: 54; Issue: 21 Linguagem: Inglês

10.1016/j.jacc.2009.06.047

1558-3597

Christophe Tribouilloy, Francesco Grigioni, Jean-François Aviérinos, Andréa Barbieri, Dan Ruşinaru, Catherine Szymanski, Marinella Ferlito, Laurence Tafanelli, Francesca Bursi, Faouzi Trojette, Angelo Branzi, Gilbert Habib, Maria Grazia Modena, Maurice Enriquez‐Sarano,

Infective Endocarditis Diagnosis and Management

This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets. LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown. The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 ± 12 years; ejection fraction: 65 ± 10%) in whom LVESD was measured (36 ± 7 mm). Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus ≥40 mm (64 ± 5% vs. 48 ± 10%; p < 0.001, and 73 ± 5% vs. 63 ± 10%; p = 0.001). LVESD ≥40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD ≥40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD ≥40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death). In MR due to flail leaflets, LVESD ≥40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD ≥40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.