Key result
LVESD ≥40 mm linked to ~95% higher mortality in conservatively managed organic MR.
Why the study?
LVESD is a marker of left ventricular function in organic mitral regurgitation, but its association with survival after diagnosis was unknown.
Does LVESD >= 40 mm predict increased mortality in patients with organic mitral regurgitation due to flail leaflets?
Cohort (n=739)
Yes
Does LVESD >= 40 mm predict increased mortality in patients with organic mitral regurgitation due to flail leaflets?
Hazard Ratio: 1.95 (95% CI 1.01–3.83)
p-value: p=0.045
LVESD >= 40 mm is independently associated with increased mortality in patients with organic mitral regurgitation due to flail leaflets, suggesting surgery should be considered before LVESD reaches 40 mm.
LVESD ≥40 mm may aid risk stratification under conservative management in flail MR; leaves open whether earlier surgery improves survival.
Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets Tribouilloy, Christophe; Grigioni, Francesco; Avierinos, Jean François; Barbieri, Andrea; Rusinaru, Dan; Szymanski, Catherine; Ferlito, Marinella; Tafanelli, Laurence; F. Bursi ; Trojette, Faouzi; Branzi, Angelo; Habib, Gilbert; Modena, Maria G.; Enriquez-Sarano, Maurice 2009 Abstract Objectives 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.Background LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown.Methods 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).Results 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).Conclusions 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.
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Tribouilloy et al. (2009) conducted a cohort in Organic mitral regurgitation due to flail leaflets (n=739). Left ventricular end-systolic diameter (LVESD) ≥40 mm vs. LVESD <40 mm was evaluated on Overall mortality under conservative management (HR 1.95, 95% CI 1.01-3.83, p=0.045). In patients with organic mitral regurgitation due to flail leaflets, an LVESD ≥40 mm was independently associated with increased overall mortality under conservative management (HR 1.95).
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