Key result
Cardiac damage staging linked to ~41% higher mortality per stage in asymptomatic primary MR.
Why the study?
Optimal timing for intervention remains uncertain in asymptomatic patients with primary mitral regurgitation.
Does a cardiac damage staging classification predict mortality and cardiovascular events in asymptomatic patients with moderate or severe primary mitral regurgitation?
Cohort (n=338)
Does a cardiac damage staging classification predict mortality and cardiovascular events in asymptomatic patients with moderate or severe primary mitral regurgitation?
Effect estimate: HR 1.41 (95% CI 1.07-1.85)
p-value: p=0.015
A novel cardiac damage staging classification provides independent and incremental prognostic value for mortality and cardiovascular events in asymptomatic patients with moderate or severe primary mitral regurgitation.
May aid prognostication in asymptomatic primary MR; hypothesis-generating pending prospective validation.
Background: Optimal timing for intervention remains uncertain in asymptomatic patients with primary mitral regurgitation (MR). We aimed to assess the prognostic value of a new cardiac damage staging classification in patients with asymptomatic moderate or severe primary MR. Methods: Clinical, Doppler-echocardiographic, and outcome data prospectively collected in 338 asymptomatic patients (64 AE 15 years, 68% men) with at least moderate primary MR were retrospectively analyzed. Patients were hierarchically classified as per the following staging classification: no cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate or severe left ventricular or left atrial damage (stage 2), pulmonary vasculature or tricuspid valve damage (stage 3), or right ventricular damage (stage 4). Results: There was a stepwise increase in 10-year mortality rates as per cardiac damage stage: 20.0% in stage 0, 25.6% in stage 1, 31.5% in stage 2, and 61.3% in stage 3-4 (p < 0.001). The staging classification was significantly associated with increased risk of mortality (hazard ratio 1.41 per one-stage increase, 95% confidence interval: 1.07-1.85, p 0.015) and the composite of cardiovascular mortality or hospitalization (hazard ratio 1.51 per one-stage increase, 95% confidence interval: 1.07-2.15, p 0.020) in multivariable analysis adjusted for Euro-SCORE II, mitral valve intervention as a time-dependent variable, and other risk factors. The proposed scheme showed incremental value over several clinical variables (net reclassification index 0.40, p 0.03). Conclusions: The new staging classification provides independent and incremental prognostic value in patients with asymptomatic moderate or severe MR.
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Bernard et al. (2022) conducted a cohort in Asymptomatic moderate or severe primary mitral regurgitation (n=338). Cardiac damage staging classification was evaluated on Mortality (HR 1.41, 95% CI 1.07-1.85, p=0.015). A new cardiac damage staging classification was significantly associated with increased mortality risk (HR 1.41 per one-stage increase; 95% CI 1.07-1.85; p=0.015) in asymptomatic primary MR.
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