Association between hypertension and primary mitral chordae tendinae rupture.
BACKGROUND
Mitral regurgitation from chordae tendinae rupture (CTR) may cause severe clinical symptoms and is a progressive disease that eventually results in the need for mitral valve surgery. Early recognition of CTR and identification of risk factors are important because early intervention increases the chances of survival. Hypertension may increase mitral valve complex mechanical strain and cause the chordae tendinae to rupture.


METHODS
Using a cross-sectional study of medical files in one medical center in Taiwan, we enrolled 98 patients with mitral CTR and classified them into two groups, comprising 68 subjects (69%) without obvious predisposing factors (primary group) and 30 subjects (31%) with known predisposing causes (secondary group).


RESULTS
Of the subjects, 63 (64%) were men with a mean age of 57.5 +/- 1.5 years. The posterior mitral leaflet was most commonly involved (64%). The known predisposing factors in secondary group include mitral valve prolapse, infective endocarditis, and rheumatic heart disease. The patients who had primary CTR were older (59.9 +/- 1.6 v 52.1 +/- 3.1 years, P = .029), had a higher prevalence of hypertension (56% v 30%, P = .018) and complained more often of dyspnea (82% v 53%, P = .003) than the patients in the secondary group. Using binary logistic regression analyses, the variation in primary group was found to be independently explained by age (P = .039, odds ratio = 1.039, 95% confidence interval = 1.002 to 1.077) and hypertension (P = .048, odds ratio = 2.717, 95% confidence interval = 1.008 to 7.326).


CONCLUSIONS
We conclude that hypertension was an independent predictor for primary CTR in this study.
Lin
Tsung-Hsien
TH
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chun-Ho Memorial Hospital, Kaohsiung Medical University, 100 Shi-Chuan 1st Road, Kaohsiung 80708, Taiwan, Republic of China. Sheush@kmu.edu.tw
Su
Ho-Ming
HM
Voon
Wen-Chol
WC
Lai
Hsiu-Mei
HM
Yen
Hsueh-Wei
HW
Lai
Wen-Ter
WT
Sheu
Sheng-Hsiung
SH
D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D002815:Chordae Tendineae / Q000473:pathology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006341:Heart Rupture / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D012044:Regression Analysis; D012307:Risk Factors; D012727:Sex Characteristics