title: Prognostic implication of valvular lesion and left ventricular size in asymptomatic patients with chronic organic mitral regurgitation and normal left ventricular performance.
abstract: OBJECTIVE
  To date, few studies have evaluated asymptomatic patients with organic mitral regurgitation (MR). The goal of the present study was to assess the presence of independent predictive factors for progression of symptoms and/or left ventricular dysfunction (SLVSD) in this population.
  
  
  METHODS
  We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% men; ejection fraction 66 +/- 3%) who were asymptomatic, with severe organic MR. Mean follow-up was 29 +/- 12 months. The combined end point was SLVSD. Clinical and echocardiographic variables were evaluated. Follow-up data were also estimated considering the annualized rate (?) of the echocardiographic indices.
  
  
  RESULTS
  Thirty-seven patients (29%) had SLVSD during follow-up. Cox regression model identified the effective regurgitant orifice area (EROA) >55 mm2 (risk ratio 6.3, 95% CI 2.3-8.1, P < .001) and end-systolic diameter >22 mm/m2 (risk ratio 4.5, 95% CI, 1.8-9.4, P < .02) as the only independent predictors of SLVSD. When the follow-up data were added, the ?EROA (>15 mm2/y) was independently associated with the end point.
  
  
  CONCLUSIONS
  In asymptomatic patients with organic MR, the EROA and the end-systolic diameter are independent predictors of SLVSD and allow a better risk stratification in this group of patients. ANALYTICAL SUMMARY: The goal of this study was to determine the presence of independent predictors of symptomatic progression, and/or left ventricular dysfunction in asymptomatic patients with severe mitral regurgitation. We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% male; ejection fraction 66 +/- 3%). During follow-up (mean 29 +/- 12 months). The end point occurred in 37 patients (29%). Multivariate analysis using Cox model identified the effective regurgitant orifice area (EROA) >55 mm2 (RR: 6.3; 95% CI: 2.3-8.1; P < .001) and an end-systolic diameter (ESD) >22 mm/m2 (RR: 4.5; 95%CI: 1.8-9.4; P < .02) as the only independent predictors of the end point. When the follow-up data were added, the annualized change rate of the EROA (>15 mm2/year) was independently associated with the end point. In asymptomatic patients with organic mitral regurgitation, the EROA and ESD at study entry were independent predictors of the combined end point and allowed a better risk stratification in this group of patients.
authors.affiliation: Cardiology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Krauss
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pizarro
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Oberti
authors.forename: Mariano
authors.initials: M
authors.lastname: Falconi
authors.forename: Arturo
authors.initials: A
authors.lastname: Cagide
mesh_terms: D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology