Key result
Atrial secondary mitral regurgitation was associated with high all-cause mortality, but survival was similar to ventricular secondary mitral regurgitation when adjusted for age and sex (HR 0.81).
Why the study?
The prevalence, clinical characteristics, management, and long-term outcomes of patients with atrial secondary mitral regurgitation are not well described.
Observational (n=388)
No
Hazard Ratio: 0.81 (95% CI 0.52–1.25)
Atrial secondary mitral regurgitation is a distinct and prevalent condition associated with poor long-term outcomes, largely driven by advanced age and comorbidities rather than the valvular lesion itself.
ASMR mortality is largely age- and comorbidity-driven; extends secondary MR classification but should not yet alter management.
BACKGROUND: The prevalence, clinical characteristics, management and long-term outcomes of patients with atrial secondary mitral regurgitation (ASMR) are not well described. METHODS: We performed a retrospective, observational study of consecutive patients with grade III/IV MR determined by transthoracic echocardiography. The aetiology of MR was grouped as being either primary (due to degenerative mitral valve disease), ventricular SMR (VSMR: due to left ventricular dilatation/dysfunction), ASMR (due to LA dilatation), or other. RESULTS: A total of 388 individuals were identified who had grade III/IV MR; of whom 37 (9.5%) had ASMR, 113 (29.1%) had VSMR, 193 had primary MR (49.7%), and 45 (11.6%) were classified as having other causes. Compared to MR of other subtypes, patients with ASMR were on average older (median age 82 [74-87] years, p < 0.001), were more likely to be female (67.6%, p = 0.004) and usually had atrial fibrillation (83.8%, p = 0.001). All-cause mortality was highest in patients with ASMR (p < 0.001), but similar to that in patients with VSMR once adjusted for age and sex (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.52-1.25). Hospitalisation for worsening heart failure was more commonly observed in those with ASMR or VSMR (p < 0.001) although was similar between these groups when age and sex were accounted for (HR 0.74, 95% CI 0.34-1.58). For patients with ASMR, the only variables associated with outcomes were age and co-morbidities. CONCLUSIONS: ASMR is a prevalent and distinct disease process associated with a poor prognosis, with much of this related to older age and co-morbidities.
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Straw et al. (2023) conducted an observational in Grade III/IV mitral regurgitation (n=388). Atrial secondary mitral regurgitation vs. Ventricular secondary mitral regurgitation was evaluated on All-cause mortality (adjusted for age and sex) (HR 0.81, 95% CI 0.52-1.25). Atrial secondary mitral regurgitation was associated with high all-cause mortality, but survival was similar to ventricular secondary mitral regurgitation when adjusted for age and sex (HR 0.81).
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