Abstract 16559: Management and Outcomes of Patients with Moderate or Severe Functional Mitral Regurgitation and Severe Left Ventricular Systolic Dysfunction
Background: Guidelines support valve surgery in patients with mitral regurgitation (MR) and left ventricular (LV) enlargement and/or dysfunction but the current management and outcomes in patients with severe LV dysfunction is not well defined. Objective: To determine the characteristics, management strategies and outcomes of patients with moderate or severe MR with LV ejection fraction (EF) ≤ 30% and/or LV end systolic dimension (ESD) > 55 mm at a referral center.
Methods: The Duke Echocardiography and Cardiovascular Diseases Databases were searched between 1995-2010 to identify patients with moderate/severe MR. Baseline characteristics and all cause mortality were compared between patients with and without severe LV dysfunction defined as LVEF ≤ 30% and/or LVESD > 55 mm. Cox proportional hazards model was utilized to examine the independent effect of treatment strategy on outcomes.
Results: Amongst 3657 patients with moderate/severe MR defined by echocardiography who underwent a concomitant invasive assessment, 1701 (46.5%) had either LVEF ≤ 30% and/or LVESD > 55 mm. While most factors were evenly distributed, there were more functional MR (97% vs 67%), heart failure history (83% vs 61%) and cigarette smoking in patients with severe LV dysfunction. Among patients with severe LV dysfunction, mitral valve surgery was performed in 12.5% at an average of 6.5 months from the initial echocardiogram; in contrast those without severe LV dysfunction received mitral valve surgery more commonly (38.6%). Compared to patients without severe LV dysfunction, the severe LV dysfunction group had a higher mortality at 1, 5 and 10 years (p<0.0001). Median survival was 5.3 vs. 7.5 years [HR=1.37 (95%CI 1.25, 1.50) p<0.0001]. Age, renal disease, previous stroke and diabetes were independently associated with mortality (p <0.0001). Mitral valve surgery alone or in combination with CABG was not independently associated with survival [HR 0.9 (95%CI 0.71, 1.16), p=0.45]
Conclusions: A large proportion of patients with moderate or severe functional MR have LVEF ≤ 30% and or LVESD > 55 mm at presentation. Mortality is substantial and mitral valve surgery may not be associated with a significant survival advantage as compared to medical therapy in this group of patients.
- © 2012 by American Heart Association, Inc.