Document Detail

Prognostic implications of mitral regurgitation in patients with severe aortic regurgitation.
MedLine Citation:
PMID:  20837924     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Mitral regurgitation (MR) is common in those with severe aortic regurgitation (AR) and can predispose to atrial fibrillation, heart failure, and a need for mitral valve surgery during aortic valve replacement (AVR). However, little data exist as to its clinical and prognostic implications. METHODS AND RESULTS: Search of our echocardiographic data base between 1993 and 2007 yielded 756 patients with severe AR. with comprehensive clinical data from chart review and mortality data from National Death Index. Mortality was analyzed as a function of MR severity. Effect of AVR and concomitant mitral valve repair were investigated. Patient characteristics were age, 61±17 years; female sex, 41%; and ejection fraction, 54±19%. MR grade ≥2+ was present in 343 (45%) patients: 2+ in 152 (20%), 3+ in 93 (12%), and 4+ in 98 (13%). There was a progressive decrease in survival with each grade of MR (P<0.0001). Performance of AVR was associated with a better survival in those with 3 or 4+ MR (P=0.02). In addition, concomitant mitral valve repair in these patients resulted in a better survival (hazard ratio, 0.29; P=0.02). CONCLUSIONS: MR is common in patients with severe AR, with 3 or 4+ MR occurring in a quarter of these patients. It is an independent predictor of reduced survival. Performance of AVR and concomitant mitral valve repair is associated with a better survival. Development of MR should serve as an indication for AVR even in asymptomatic patients.
Ramdas G Pai; Padmini Varadarajan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S43-7     Citation Subset:  AIM; IM    
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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MeSH Terms
Aged, 80 and over
Aortic Valve Insufficiency* / complications,  mortality,  surgery
Atrial Fibrillation / etiology,  mortality,  surgery
Disease-Free Survival
Heart Failure / etiology,  mortality,  surgery
Middle Aged
Mitral Valve Insufficiency* / complications,  mortality,  surgery
Retrospective Studies
Severity of Illness Index
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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