Key result
Mitral valve annuloplasty shows no mortality benefit in significant MR with severe LV dysfunction.
Why the study?
Mitral valve annuloplasty improves hemodynamics and symptoms in patients with MR and LV systolic dysfunction, but its effects on long-term mortality are not well established.
Does mitral valve annuloplasty reduce the risk of death or need for advanced heart failure therapies in patients with significant mitral regurgitation and left ventricular systolic dysfunction?
Cohort (n=419)
Does mitral valve annuloplasty reduce the risk of death or need for advanced heart failure therapies in patients with significant mitral regurgitation and left ventricular systolic dysfunction?
Absolute Event Rate: 49% vs 41%
In a retrospective cohort, mitral valve annuloplasty did not confer a demonstrable mortality or advanced heart failure therapy benefit in patients with significant mitral regurgitation and severe LV dysfunction.
OBJECTIVES: This study was designed to assess effects of mitral valve annuloplasty (MVA) on mortality in patients with mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction. BACKGROUND: Mitral valve annuloplasty improves hemodynamics and symptoms in these patients, but effects on long-term mortality are not well established. METHODS: We retrospectively analyzed consecutive patients with significant MR and LV systolic dysfunction on echocardiography between 1995 and 2002. Cox regression analysis, including MVA as a time-dependent covariate and propensity scoring to adjust for differing probabilities of undergoing MVA, was used to identify predictors of death, LV assist device implantation, or United Network for Organ Sharing-1 heart transplantation. RESULTS: Of 682 patients identified, 419 were deemed surgical candidates; 126 underwent MVA. Propensity score derivation identified age, ejection fraction, and LV dimension to be associated with undergoing MVA. End points were reached in 120 (41%) non-MVA and 62 (49%) MVA patients. Increased risk of end point was associated with coronary artery disease (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.30 to 2.49), blood urea nitrogen (HR 1.01, 95% CI 1.005 to 1.02), cancer (HR 2.77, 95% CI 1.45 to 5.30), and digoxin (HR 1.66, 95% CI 1.15 to 2.39). Reduced risk was associated with angiotensin-converting enzyme inhibitors (HR 0.65, 95% CI 0.44 to 0.95), beta-blockers (HR 0.59, 95% CI 0.42 to 0.83), mean arterial pressure (HR 0.98, 95% CI 0.97 to 0.99), and serum sodium (HR 0.93, 95% CI 0.90 to 0.96). Mitral valve annuloplasty did not predict clinical outcome. CONCLUSIONS: In this analysis, there is no clearly demonstrable mortality benefit conferred by MVA for significant MR with severe LV dysfunction. A prospective randomized control trial is warranted for further study of mortality with MVA in this population.
No takes yet. Share an insight, caveat, or question.
Wu et al. (2005) conducted a cohort in Mitral regurgitation and left ventricular systolic dysfunction (n=419). Mitral valve annuloplasty vs. No mitral valve annuloplasty was evaluated on Death, left ventricular assist device implantation, or United Network for Organ Sharing-1 heart transplantation. Mitral valve annuloplasty did not confer a demonstrable mortality benefit in patients with significant mitral regurgitation and severe LV dysfunction (composite endpoint 49% vs 41% without MVA).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: