PROGNOSTIC VALUE OF A CARDIAC DAMAGE STAGING CLASSIFICATION IN PATIENTS WITH ASYMPTOMATIC PRIMARY MITRAL REGURGITATION
CCC ePoster Library. Bernard J. 10/26/19; 280535; 300
Mr. Jérémy Bernard
Mr. Jérémy Bernard
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Abstract
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BACKGROUND: The timing for intervention in asymptomatic primary mitral regurgitation (MR) remains a matter of debate. Furthermore, the absence of symptoms does not exclude the presence of cardiac chambers dysfunction. The objective of this study was to assess the prognostic value of a new staging classification characterizing the extent of cardiac damage in patients with asymptomatic primary MR.

METHODS AND RESULTS: Clinical and Doppler-echocardiographic data of 344 prospectively enrolled asymptomatic patients (mean age 64±15 years, 57% men) with ≥mild primary MR were retrospectively analyzed. Patients were hierarchically classified according to the following staging classification: Stage 0: No cardiac damage; Stage 1: Mild left ventricular (LV) or left atrial (LA) damage [LV end-diastolic diameter (LVEDD) >40mm, LV end-systolic diameter (LVESD) >30mm, forward LV ejection fraction (LVEF) ≤60% or indexed LA volume (LAV) ≥40ml/m²]; Stage 2: Moderate LV or LA damage [LVEDD >60mm, LVESD >40mm, forward LVEF ≤50%, indexed LAV ≥60ml/m² or presence of atrial fibrillation]; Stage 3: Pulmonary vasculature or tricuspid damage [systolic pulmonary artery pressure (SPAP) ≥50mmHg or ≥moderate tricuspid regurgitation]; Stage 4: Right ventricular damage [≥moderate right ventricular dysfunction] or low flow state defined as indexed LV stroke volume < 30ml/m². At inclusion, none of the patients were in Stage 0, 38% (n=131) were in Stage 1, 29.7% (n=102) in Stage 2, and 32.3% (n=111) in Stage 3 or 4. During a median follow-up of 5.7 (2.8-8.9) years, there were 89 deaths (25 of cardiovascular causes) and 153 mitral valve (MV) intervention. There was a stepwise increase in the rates of mortality and of the composite of mortality and MV intervention with more advanced cardiac damage stage (all, p < 0.001 - Figure). In multivariate cox proportional analysis adjusted for age, sex, comorbidities and LVEF, more advanced staging was associated with increased risk of mortality (HR [95% CI]: 1.40 [1.06-1.85] per one stage increase, p=0.02) and MV intervention (1.32 [1.05 - 1.67], p=0.02), and with the composite of mortality and MV intervention (1.29 [1.09-1.53], p=0.003).

CONCLUSION: This newly proposed cardiac damage staging classification objectively provides good prognostic value to predict mortality and occurrence of MV surgery. This staging classification may be useful to identify patients who may benefit from earlier intervention.
BACKGROUND: The timing for intervention in asymptomatic primary mitral regurgitation (MR) remains a matter of debate. Furthermore, the absence of symptoms does not exclude the presence of cardiac chambers dysfunction. The objective of this study was to assess the prognostic value of a new staging classification characterizing the extent of cardiac damage in patients with asymptomatic primary MR.

METHODS AND RESULTS: Clinical and Doppler-echocardiographic data of 344 prospectively enrolled asymptomatic patients (mean age 64±15 years, 57% men) with ≥mild primary MR were retrospectively analyzed. Patients were hierarchically classified according to the following staging classification: Stage 0: No cardiac damage; Stage 1: Mild left ventricular (LV) or left atrial (LA) damage [LV end-diastolic diameter (LVEDD) >40mm, LV end-systolic diameter (LVESD) >30mm, forward LV ejection fraction (LVEF) ≤60% or indexed LA volume (LAV) ≥40ml/m²]; Stage 2: Moderate LV or LA damage [LVEDD >60mm, LVESD >40mm, forward LVEF ≤50%, indexed LAV ≥60ml/m² or presence of atrial fibrillation]; Stage 3: Pulmonary vasculature or tricuspid damage [systolic pulmonary artery pressure (SPAP) ≥50mmHg or ≥moderate tricuspid regurgitation]; Stage 4: Right ventricular damage [≥moderate right ventricular dysfunction] or low flow state defined as indexed LV stroke volume < 30ml/m². At inclusion, none of the patients were in Stage 0, 38% (n=131) were in Stage 1, 29.7% (n=102) in Stage 2, and 32.3% (n=111) in Stage 3 or 4. During a median follow-up of 5.7 (2.8-8.9) years, there were 89 deaths (25 of cardiovascular causes) and 153 mitral valve (MV) intervention. There was a stepwise increase in the rates of mortality and of the composite of mortality and MV intervention with more advanced cardiac damage stage (all, p < 0.001 - Figure). In multivariate cox proportional analysis adjusted for age, sex, comorbidities and LVEF, more advanced staging was associated with increased risk of mortality (HR [95% CI]: 1.40 [1.06-1.85] per one stage increase, p=0.02) and MV intervention (1.32 [1.05 - 1.67], p=0.02), and with the composite of mortality and MV intervention (1.29 [1.09-1.53], p=0.003).

CONCLUSION: This newly proposed cardiac damage staging classification objectively provides good prognostic value to predict mortality and occurrence of MV surgery. This staging classification may be useful to identify patients who may benefit from earlier intervention.
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