Abstract 3552: Mitral Regurgitation in Patients With Severe Aortic Regurgitation: Mechanisms and Prognostic Implications
Introduction: Mitral regurgitation (MR) is common in those with severe aortic regurgitation (AR). It can potentially predispose to atrial fibrillation, heart failure and a need for mitral valve surgery during aortic valve replacement (AVR). Hence, we investigated its impact on survival in a large cohort of patients with severe AR.
Methods: Search of our echocardiographicmdata-base between 1993 to 2007 yielded 785 patients with severe AR. Chart reviews were conducted to collect clinical data. MR grade ≥2+ was present in 356 (45%) patients: 2+ in 159 (20%), 3+ in 96 (12%) and 4+ in 101 (13%). Mortality data was obtained from National death index.
Results: Patient characteristics: age 61±17 years; females 41%, EF 54±19%. There was a progressive decrease in survival with each grade of MR in the whole cohort as well as the surgically and medically treated subsets (p<0.0001). AVR was performed in 320 patients during follow-up with AVR rates being 34% in those with 3 or 4+ AR compared 40% in those with lesser grades of MR (p=0.16). Survival in those with 3 or 4 + MR was 42% compared to 70% for those without, in the whole cohort (p<0.0001), 36% vs 60% in those without AVR (p<0.0001) and 70% vs 85% in those who underwent AVR (p<0.0001). Presence of 3 and 4+ MR was associated with a larger LV (p<0.0001), thinner LV walls (p=0.0002), lower EF (p<0.0001), greater age (p=0.0001), female gender (p=0.0007), coronary artery disease (p<0.0001), renal insufficiency (p=0.0002), greater degrees of tricuspid regurgitation (p<0.0001) and atrial fibrillation (p<0.0001). It remained an independent predictor of lower survival after adjusting for these group differences in all the patients as well as in the surgical cohort. AVR was associated with a better survival in those with 3 or 4+ MR.
MR is common in patients with severe AR, 3 or 4+ MR occurring in a quarter of these patients.
It is an independent predictor of reduced survival.
Despite a lower AVR rate, AVR is associated with a better survival in those with significant MR.
Development of MR should serve as an indication for AVR even in asymptomatic patients.