Progression of Mitral Regurgitation in Rheumatic Valve Disease: Role of Left Atrial Remodeling

Frontiers in Cardiovascular Medicine

article

Nayana F. A. Gomes¹  Vicente Rezende Silva¹  Robert A. Levine²  William A. M. Esteves¹  Marildes Luiza de Castro¹  Livia S. A. Passos³  Jacob P. Dal-Bianco²  Alexandre Negrão Pantaleão¹  Jose Luiz Padilha da Silva⁴  Timothy C. Tan⁵  Walderez O. Dutra⁶  Elena Aikawa³  Judy Hung²  Maria Carmo P. Nunes¹ 

[1] School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais;Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital;The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School;Department of Statistics, Federal University of Paraná;Department of Cardiology, Blacktown Hospital, University of Western Sydney;Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology

关键词: progression;    atrial fibrillation;    mitral stenosis;    left atrial;    mitral regurgitation;    rheumatic heart disease;   

DOI  :  10.3389/fcvm.2022.862382

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Introduction Mitral regurgitation (MR) is the most common valve abnormality in rheumatic heart disease (RHD) often associated with stenosis. Although the mechanism by which MR develops in RHD is primary, longstanding volume overload with left atrial (LA) remodeling may trigger the development of secondary MR, which can impact on the overall progression of MR. This study is aimed to assess the incidence and predictors of MR progression in patients with RHD. Methods Consecutive RHD patients with non-severe MR associated with any degree of mitral stenosis were selected. The primary endpoint was a progression of MR, which was defined as an increase of one grade in MR severity from baseline to the last follow-up echocardiogram. The risk of MR progression was estimated accounting for competing risks. Results The study included 539 patients, age of 46.2 ± 12 years and 83% were women. At a mean follow-up time of 4.2 years (interquartile range [IQR]: 1.2–6.9 years), 54 patients (10%) displayed MR progression with an overall incidence of 2.4 per 100 patient-years. Predictors of MR progression by the Cox model were age (adjusted hazard ratio [HR] 1.541, 95% CI 1.222–1.944), and LA volume (HR 1.137, 95% CI 1.054–1.226). By considering competing risk analysis, the direction of the association was similar for the rate (Cox model) and incidence (Fine-Gray model) of MR progression. In the model with LA volume, atrial fibrillation (AF) was no longer a predictor of MR progression. In the subgroup of patients in sinus rhythm, 59 had an onset of AF during follow-up, which was associated with progression of MR (HR 2.682; 95% CI 1.133–6.350). Conclusions In RHD patients with a full spectrum of MR severity, progression of MR occurs over time is predicted by age and LA volume. LA enlargement may play a role in the link between primary MR and secondary MR in patients with RHD.

【 授权许可】

CC BY