Key result
Permanent moderate FMR linked to ~88% higher mortality after isolated AVR.
Why the study?
Referral and admission echocardiography may differ in assessing moderate functional mitral regurgitation in patients scheduled for aortic valve replacement with aortic stenosis, creating a need to determine truly moderate functional mitral regurgitation and its impact on survival.
Does the presence of permanent versus incidental moderate functional mitral regurgitation affect mid-term survival in patients undergoing isolated aortic valve replacement for severe aortic stenosis?
Observational (n=679)
No
Does the presence of permanent versus incidental moderate functional mitral regurgitation affect mid-term survival in patients undergoing isolated aortic valve replacement for severe aortic stenosis?
Hazard Ratio: 1.88 (95% CI 1.05–3.37)
Absolute Event Rate: 60.6% vs 84.1%
p-value: p=0.03
In patients undergoing isolated aortic valve replacement for severe aortic stenosis, permanent moderate functional mitral regurgitation confirmed on two separate echocardiograms is a strong predictor of mid-term mortality, whereas an incidental finding of moderate FMR is not.
Permanent moderate FMR was associated with higher mortality after isolated AVR; leaves open whether concomitant mitral intervention improves survival.
BACKGROUND: Referral and admission echocardiography (ECHO) in patients scheduled for aortic valve replacement (AVR) with aortic stenosis (AS) may differ in the assessment of moderate functional mitral regurgitation (FMR). AIMS: Our study aimed to determine truly moderate FMR and evaluate its impact on survival. METHODS: We conducted an observational study of patients referred for AVR with AS and no, mild, or moderate FMR between 2014 and 2019. Patients were assigned into three groups: (1) no/mild (N-FMR); (2) moderate-FMR on one ECHO (either at referral or on admission) termed incidental (I-FMR); (3) moderate FMR in two studies (both at referral and on admission) termed permanent (PM-FMR). RESULTS: The referral and admission assessment were performed median 35 days apart. Of the 679 elective patients who underwent elective isolated AVR, 516 patients had N-FMR, 102 patients had I-FMR, and 61 patients had PM-FMR. Median follow-up was 46 months (22.5-58.5); max 73.3. Thirty-day mortality was 2.5% vs. 1% vs. 8.2% (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.01). Five-year survival was 84.1% in N-FMR vs. 88.5% in I-FMR vs. 60.6% in the PM-FMR group, where it was the lowest (P < 0.001). In multivariable modeling, PM-FMR increased mortality (hazard ratio [HR], 1.88 [1.05-3.37]; P = 0.03). I-FMR had no effect on mortality (HR, 0.67 [0.32-1.37]; P = 0.28). Five-year survival after excluding 30-day mortality was 86.3% vs. 89.4% vs. 66.0%; (N-FMR vs. I-FMR vs. PM-FMR, respectively; P = 0.02). PM-FMR increased late mortality (HR, 2.17 [1.14-4.15]; P = 0.01). CONCLUSIONS: In patients undergoing isolated AVR for AS, the presence of permanent moderate FMR significantly impacts 30-day and mid-term survival.
No takes yet. Share an insight, caveat, or question.
Kowalówka et al. (2023) conducted an observational in Aortic stenosis with functional mitral regurgitation (n=679). Permanent moderate functional mitral regurgitation (PM-FMR) vs. No/mild functional mitral regurgitation (N-FMR) was evaluated on Mid-term survival (mortality) (HR 1.88, 95% CI 1.05-3.37, p=0.03). Permanent moderate functional mitral regurgitation significantly increased mortality (HR 1.88) and reduced 5-year survival to 60.6% compared to 84.1% in patients with no or mild regurgitation undergoing isolated aortic valve replacement.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: