Outcomes and predictors of cardiac events in medically treated patients with atrial functional mitral regurgitation

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:316

Article

Kim, Kitae¹  Kitai, Takeshi¹  Kaji, Shuichiro¹  Pak, Misun¹  Toyota, Toshiaki¹  Sasaki, Yasuhiro¹  Ehara, Natsuhiko¹  Kobori, Atsushi¹  Kinoshita, Makoto¹  Furukawa, Yutaka¹ 

[1] Kobe City Med Ctr Gen Hosp, Dept Cardiovasc Med, Chuo Ku, 2-1-1 Minatojima Minamimachi, Kobe, Hyogo 6500047, Japan

关键词: Atrial fibrillation;    Functional mitral regurgitation;    Heart failure;    Mitral valve surgery;   

DOI  :  10.1016/j.ijcard.2020.06.042

来源: Elsevier

【 摘 要 】

Background: Little is known about the outcomes and predictors of adverse cardiac events in medically treated patients with atrial functional mitral regurgitation (FMR). Methods: We screened 1405 consecutive patients with grade >= 3+ mitral regurgitation (MR) detected by echocardiography. After excluding patients with previous or early (within 3 months from diagnosis) mitral valve surgery, congenital heart disease, hypertrophic cardiomyopathy, severe aortic valve disease, or unknown etiology, the study population consisted of 319 patients with primary MR, 395 patients with FMR with left ventricular (LV) dysfunction, and 184 patients with atrial FMR. Atrial FMR was defined as FMR in patients without LV wall motion abnormality or dilatation. Results: The cumulative incidence of the composite of cardiac death and heart failure hospitalization at 3 years was 10.5% in primary MR, 37.5% in FMR with LV dysfunction, and 14.0% in atrial FMR (p < .001). In atrial FMR patients, LV end-diastolic volume index (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.02-1.10), severe MR (grade 4+) (HR 2.73, 95% CI 1.21-6.12), being symptomatic (NYHA >= 2) (HR 2.82, 95% CI 1.15-6.92), and having >= 1 comorbidities (HR 3.96, 95% CI 1.74-9.00) were independently associated with an increased risk for adverse cardiac events by a multivariable Cox regression analysis. Conclusions: Outcomes of medically treated patients with atrial FMR were better than those of FMR with LV dysfunction, but worse than those of primary MR. In atrial FMR patients, LV dilatation, severe MR, being symptomatic, and the presence of comorbidities were independently associated with an increased risk for adverse cardiac events. (C) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

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