Key result
Five distinct phenogroups of patients with severe primary mitral regurgitation undergoing valve surgery had significantly different 5-year survival rates ranging from 83.4% to 98.5% (p<0.001).
Why the study?
Patients with mitral regurgitation may be heterogeneous with different risk profiles, prompting the identification of distinct phenogroups of severe primary MR to investigate long-term post-surgical prognosis.
Does phenogrouping using latent class analysis predict long-term mortality in patients with severe primary mitral regurgitation undergoing mitral valve surgery?
Cohort (n=2,321)
Does phenogrouping using latent class analysis predict long-term mortality in patients with severe primary mitral regurgitation undergoing mitral valve surgery?
p-value: p=<0.001
Latent class analysis identifies five distinct phenogroups of patients with severe primary mitral regurgitation that effectively stratify long-term mortality risk after mitral valve surgery.
Phenogrouping may stratify mortality risk after mitral valve surgery; hypothesis-generating and requires validation before guiding decisions.
OBJECTIVES: Patients with mitral regurgitation (MR) may be heterogeneous with different risk profiles. We aimed to identify distinct phenogroups of patients with severe primary MR and investigate their long-term prognosis after mitral valve (MV) surgery. METHODS: The retrospective cohort of patients with severe primary MR undergoing MV surgery (derivation, n=1629; validation, n=692) was analysed. Latent class analysis was used to classify patients into subgroups using 15 variables. The primary outcome was all-cause mortality after MV surgery. RESULTS: During follow-up (median 6.0 years), 149 patients (9.1%) died in the derivation cohort. In the univariable Cox analysis, age, female, atrial fibrillation, left ventricular (LV) end-systolic dimension/volumes, LV ejection fraction, left atrial dimension and tricuspid regurgitation peak velocity were significant predictors of mortality following MV surgery. Five distinct phenogroups were identified, three younger groups (group 1-3) and two older groups (group 4-5): group 1, least comorbidities; group 2, men with LV enlargement; group 3, predominantly women with rheumatic MR; group 4, low-risk older patients; and group 5, high-risk older patients. Cumulative survival was the lowest in group 5, followed by groups 3 and 4 (5-year survival for groups 1-5: 98.5%, 96.0%, 91.7%, 95.6% and 83.4%; p<0.001). Phenogroups had similar predictive performance compared with the Mitral Regurgitation International Database score in patients with degenerative MR (3-year C-index, 0.763 vs 0.750, p=0.602). These findings were reproduced in the validation cohort. CONCLUSION: Five phenogroups of patients with severe primary MR with different risk profiles and outcomes were identified. This phenogrouping strategy may improve risk stratification when optimising the timing and type of interventions for severe MR.
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Kwak et al. (2022) conducted a cohort in severe primary mitral regurgitation (n=2,321). Distinct phenogroups vs. Other phenogroups was evaluated on all-cause mortality after MV surgery (p=<0.001). Five distinct phenogroups of patients with severe primary mitral regurgitation undergoing valve surgery had significantly different 5-year survival rates ranging from 83.4% to 98.5% (p<0.001).
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