Independent predictors of sympomatic progression andworsening of stress electrocardiogram

pp 83-92

Abstract

Background

To date, few studies have evaluated patients (pts) with asymptomatic mitral regurgitation. The objective of this study was to determine independent predictors of symptomatic progression, worsening of stress electrocardiogram and/or left ventricular systolic dysfunction (SLVSD) in this population.

Methods

We prospectively evaluated 132 consecutive pts (age 58±8years; 68% male; ejection fraction [EF] 59%±6%) with asymptomatic severe organic mitral regurgitation. Mean follow-up was 29±12 months.The combined end point was symptomatic progression, stress electrocardiogram worsening and/or left ventricular systolic dysfunction (EF <50%).Clinical and echocardiographic variables were: age at baseline, gender, atrial fibrillation, co morbidity, anterior or posterior mitral leaflet compromise, new flail leaflet(NFL), end diastolic diameter (EDD) end systolic diameter(ESD), atrial volume (AV); pulmonary artery systolic pressure (PASP); E wave peak velocity (E) and effective regurgitant orifice area (ERO) at entry and the annualized rate of change (D) of these variables on serial follow-up. We determined the best cut-off point value by the upper 25%(percentile 75): EDD (>35 mm/m2); ESD (>22 mm/m2); AV(>120 cm3); PASP (>35 mmHg.); E (>120 cm/sec); ERO(>50 mm2), DEDD (>5 mm); DESD (>5 mm/year); DAV (>20cm3/year); DPASP (>10 mmHg./ year); DE (>20 cm/sec/year);DERO (>15 mm2/year).

Results

Thirty-nine pts (29.5%) had SLVSD at follow-up. In univariate analysis, EDD >35 mm/m2 (p<0.004); ESD >45mm (p<0.0001); ERO >50 mm2 (p<0.0001); AV >120 cm3(p<0.02); E >120 cm/sec (p<0.02); PASP >35 mmHg(p<0.016); NFL (p=0.019) and ESD >22 mm/m2 at baseline(p<0.003) and DEDD (p<0.004); DESD (p<0.002); DERO(p<0.0001); DAV (p<0.002); DPSP (p<0.016) were predictors of the combined end-point.Cox model multivariate analysis identified ERO >50 mm2(RR: 6.3; CI 95% 2.4-8.4; p<0.0001), DFS >22 mm/m2 (RR:4.7; CI 95%: 1.7-9.1; p<0.02) and DERO >15 mm2 (RR: 4.3;CI 95% 2.2-6.4; p<0.001) as the only independent predictors of SLVSD.

Conclusion

In pts with asymptomatic organic mitral regurgitation ERO,ESD and DERO were independent predictors of SLVSD and allowed better stratification of this group of pts.