Abstract 15433: Prevalence and Natural History of Moderate or Severe Mitral Regurgitation: an Observational Study from a Single Center
Background: Mitral regurgitation (MR) is common and its management remains controversial despite diagnostic and surgical advances. Understanding the prevalence and natural history of moderate or severe MR is fundamental to further investigations on the public health impact of emerging treatment approaches.
Objective: To determine the prevalence and natural history of moderate or severe MR among patients referred to a tertiary-care hospital setting.
Methods: The Duke Echocardiography and Duke Cardiovascular (CV) Diseases Databases were systematically searched between 1995 and 2010 for patients presenting with moderate to severe MR. Among patients who underwent echocardiography and cardiac catheterization (CC) within 1 year, we defined a potential high surgical risk cohort by echocardiographic criteria (functional or degenerative MR, an ejection fraction (EF) > 20%, and end diastolic dimension < 60 mm) with at least one of the following: age <75 + EF<35%, functional MR + EF <40%, > 2 prior chest surgeries, hepatic cirrhosis, dialysis, chronic lung disease, prior stroke, prior CV intervention). All cause mortality was compared among those patients defined with and without high-surgical risk.
Results: Among 124991 patients who underwent a clinically-ordered echocardiogram, CC or both, 11965 (9.6%) demonstrated moderate or severe MR. Among the 4998 patients who had an echocardiogram and a cardiac catheterization within 1 year, the mean age was 64 yrs, and 50% were men. The median EF was 40% and median end systolic and end diastolic dimensions were 42mm and 53 mm, respectively. Concomitant CV disease and symptoms were frequent: 63% hypertensive, 28% diabetic, 32% with a history of CABG or PCI, 60% with ≥ 1 vessel disease and 59% with ≥ NYHA Class II heart failure. We identified 2397 (48%) patients who met the high-surgical risk criteria. All cause death rates were uniformly higher among this high-surgical risk group (39% vs. 31% at 3 yrs) HR = 1.3 (95% CI 1.2,1.5; p <0.0001).
Conclusions: The prevalence of moderate or severe MR in patients presenting to a single tertiary care center is higher than previously known. This group of patients, particularly those with high surgical risk features, have a substantial mortality at 3 years.
- © 2011 by American Heart Association, Inc.