Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography

Q: What are the key findings of this study?

Moderate mitral regurgitation was associated with a 1.67-fold higher risk of long-term all-cause mortality compared with no or trivial mitral regurgitation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Moderate and severe mitral regurgitation (n=608570). Intervention: Moderate mitral regurgitation vs. No or trivial mitral regurgitation. Primary outcome: All-cause mortality (HR 1.67, 95% CI 1.65-1.70, p=<0.001).

Q: What question did this study set out to answer?

To examine the prognostic impact of moderate and severe mitral regurgitation on long-term all-cause and cardiovascular-related mortality.

David Playford; Simon Stewart; Sarah Ann Harris; G. Scalia; David S. Celermajer; Liza Thomas; E. Paratz; Yih‐Kai Chan; Geoff Strange

doi:10.1136/heartjnl-2024-324790

December 20, 2024ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam)Open Access

Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography

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Key result

Moderate mitral regurgitation is linked to ~67% higher long-term all-cause mortality vs. trivial MR.

HR 1.67
95% CI 1.65-1.70
P<0.001
n=608,570

Figures

Why the study?

Although the prognostic implications of severe mitral regurgitation are well recognised, they are less clear in moderate mitral regurgitation.

Does moderate and severe mitral regurgitation increase all-cause and cardiovascular-related mortality in patients undergoing echocardiography?

Key Points

To examine the prognostic impact of moderate and severe mitral regurgitation on long-term all-cause and cardiovascular-related mortality.
Analyzed echocardiography reports from 608 570 individuals (319 808 men and 288 762 women aged 62.1±18.5 years) using natural language processing within the National Echocardiography Database Australia (ACTRN12617001387314).
Categorized mitral regurgitation severity into no/trivial (n=456 989; 75.1%), mild (n=102 950; 16.9%), moderate (n=38 504; 6.3%), and severe (n=10 127; 1.7%), identifying leaflet pathology and functional subtypes.
Assessed all-cause mortality (153 612 events) and cardiovascular-related mortality (47 840 events) over a median follow-up of 1541 days (IQR 820 to 2629).
Actual 5-year all-cause mortality increased with mitral regurgitation severity, reaching 54.6% in moderate and 67.5% in severe regurgitation compared to 19.2% in no/trivial cases.
Adjusted for age, sex, and leaflet pathology, all-cause mortality was higher in moderate (HR 1.67, 95% CI 1.65 to 1.70) and severe cases (HR 2.36, 95% CI 2.30 to 2.42; both p<0.001) compared with no/trivial regurgitation.
Mild regurgitation was also associated with increased risk of death (adjusted HR 1.21, 95% CI 1.20 to 1.23, p<0.001), and the prognostic risk persisted for cardiovascular mortality across functional and leaflet pathology subgroups.

Study Design

Type

Cohort (n=608,570)

Multicenter

Yes

Structured PICO

Does moderate and severe mitral regurgitation increase all-cause and cardiovascular-related mortality in patients undergoing echocardiography?

P

Population

608,570 adults undergoing echocardiography without prior mitral valve intervention, followed for a median of 1,541 days to assess the prognostic impact of mitral regurgitation severity.

E

Exposure

Presence of moderate and severe mitral regurgitation (MR) identified via natural language processing of echocardiography reports.

C

Comparator

No or trivial mitral regurgitation (MR) identified on echocardiography.

O

Outcome

All-cause mortality and cardiovascular-related mortality.hard clinical

Main Result

Hazard Ratio: 1.67 (95% CI 1.65–1.7)

Absolute Event Rate: 51.6% vs 19.8%

p-value: p=<0.001

In a large, real-world cohort, moderate and severe mitral regurgitation were both independently associated with significantly increased long-term all-cause and cardiovascular mortality compared to no or trivial regurgitation.

Limitations

Reliance on NLP extraction to detect MR, which may have included subjective determination of MR severity
Does not currently capture detailed socioeconomic variables, clinical symptoms, pharmacotherapy, or non-cardiac comorbidities
Blood pressure and dynamic loading conditions were not routinely reported
Unable to exclude a small number of cases with acute MR
Lack of detailed socioeconomic variables, clinical symptoms, pharmacotherapy, and non-cardiac comorbidities.
Reliance on natural language processing (NLP) of text reports, which may include subjective determination of MR severity.
Blood pressure and dynamic loading conditions were not routinely reported.
Inability to discount acute MR cases.
Broad classification of leaflet pathology compared to more complex clinical surgical classifications.

Implication

Moderate MR signals higher mortality risk; extends large-scale observational data but leaves open whether intervention improves outcomes.

Abstract

BACKGROUND: Although the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort. METHODS: Echocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events). RESULTS: There were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years). CONCLUSIONS: Within a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12617001387314).

Discussion

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Cite This Study

Playford et al. (2024) conducted a cohort in Moderate and severe mitral regurgitation (n=608,570). Moderate mitral regurgitation vs. No or trivial mitral regurgitation was evaluated on All-cause mortality (HR 1.67, 95% CI 1.65-1.70, p=<0.001). Moderate mitral regurgitation was associated with a 1.67-fold higher risk of long-term all-cause mortality compared with no or trivial mitral regurgitation.

synapsesocial.com/papers/6a35dc5921d3e324cb731819 https://doi.org/10.1136/heartjnl-2024-324790

Topics

Mitral valve intervention

Echocardiography

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Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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