Document Detail

Pulmonary hypertension and long-term mortality in aortic and mitral regurgitation.
MedLine Citation:
PMID:  21035592     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Outcomes data in patients with aortic regurgitation or mitral regurgitation have been limited to small series with generally <10 years of follow-up. The quantitative impact of pulmonary artery hypertension has not been well described. The purpose of this study was to describe the 15-year mortality of aortic regurgitation and mitral regurgitation.
METHODS: Our institution's electronic echocardiography database was queried to identify those patients examined in 1992 and reported to have at least mild aortic regurgitation or mitral regurgitation. Patients were classified by semi-quantitative degree of regurgitation. Pulmonary artery systolic pressure was categorized as normal, borderline, mild, or moderate or greater hypertension (pulmonary artery systolic pressure >40 mm Hg). Age-stratified Cox proportional hazards models compared survival among groups and adjusted for sex, depressed left ventricular ejection fraction, and pulmonary artery systolic pressure. Mortality data were obtained from the 2008 Social Security Death Index.
RESULTS: Of 4984 echocardiograms performed in 4050 patients, 1156 patients (28%; aged 72±14 years) had at least mild aortic regurgitation and 1971 patients (49%; aged 69±16 years) had at least mild mitral regurgitation. Overall 15-year mortality in patients with aortic regurgitation was 74% and similar for all grades of aortic regurgitation. Overall 15-year mortality in patients with mitral regurgitation was 71% and got progressively worse with increasing severity grade of mitral regurgitation (63% for mild to 81% for at least moderate-to-severe). For both aortic and mitral regurgitation, moderate or greater pulmonary artery systolic hypertension was associated with increased mortality (in patients with aortic regurgitation, hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.58-2.41, and in mitral regurgitation patients, HR, 1.48; 95% CI, 1.26-1.75).
CONCLUSION: Long-term (15-year) survival of patients with aortic regurgitation is poor and is independent of regurgitation severity. In contrast, long-term survival of patients with mitral regurgitation correlates with regurgitation severity. For both groups, moderate or greater pulmonary artery systolic hypertension identified those at highest risk.
Matthew W Parker; Murray A Mittleman; Carol A Waksmonski; Greg Sanders; Marilyn F Riley; Pamela S Douglas; Warren J Manning
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-01     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1043-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
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MeSH Terms
Age Factors
Aortic Valve Insufficiency / complications,  mortality*
Confidence Intervals
Hypertension, Pulmonary / complications,  mortality*
Kaplan-Meier Estimate
Mitral Valve Insufficiency / complications,  mortality*
Proportional Hazards Models
Sex Factors
Stroke Volume

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

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