Key result
Lack of PV flow improvement after mitral valve repair is linked to ~132% higher mortality.
Why the study?
Pulmonary vein flow patterns change after reducing mitral regurgitation severity, but the prognostic value of these changes following mitral valve repair was uncharacterized.
Does a lack of improvement in pulmonary vein flow pattern after surgical repair for primary mitral regurgitation predict all-cause mortality?
Cohort (n=216)
Does a lack of improvement in pulmonary vein flow pattern after surgical repair for primary mitral regurgitation predict all-cause mortality?
A lack of improvement in pulmonary vein flow pattern after surgical repair for primary mitral regurgitation is independently associated with worse long-term survival.
May signal higher-risk patients for closer monitoring after mitral repair; hypothesis-generating for prospective validation.
BACKGROUND: The pulmonary vein (PV) flow pattern is influenced by the presence of mitral regurgitation (MR). After a successful reduction in MR severity, the pattern is expected to be changed. We aimed to evaluate the prognostic value of a change in the PV flow pattern in patients with primary MR undergoing mitral valve repair (MVR). METHODS: The PV flow pattern was assessed with transthoracic echocardiography in 216 patients (age 65 [IQR 56-72] years, 70% male) with primary MR before and after surgical MVR. The population was divided according to a change in the PV flow pattern following MVR into 'improvers' and 'non-improvers'. RESULTS: Non-improvers (15%) had a higher prevalence of paroxysmal AF at baseline (46% vs. 22%, p = 0.004), left ventricular dysfunction (LVEF ≤60%) (39% vs. 21%, p = 0.020), and had lower systolic pulmonary artery pressure (28[IQR 25-38] vs. 35[IQR 26-48] mmHg, p = 0.018) compared to improvers (85%). After a median follow-up of 83[IQR 43-140] months, 26(12%) patients died. Non-improvers had higher mortality rates than improvers (p = 0.009). On multivariable Cox regression analysis, a lack of improvement in the PV flow pattern remained independently associated with all-cause mortality (HR 2.322, 95% CI 1.140 to 4.729, P = 0.020). CONCLUSION: A lack of improvement in the PV flow pattern is independently associated with worse long-term survival in patients with primary MR undergoing MVR.
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Yedidya et al. (2024) conducted a cohort in Primary mitral regurgitation (n=216). Lack of improvement in pulmonary vein flow pattern vs. Improvement in pulmonary vein flow pattern was evaluated on All-cause mortality (HR 2.322, 95% CI 1.140-4.729, p=0.020). A lack of improvement in the pulmonary vein flow pattern after surgical mitral valve repair was independently associated with increased all-cause mortality (HR 2.322; 95% CI 1.140-4.729; P=0.020).
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