title: Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study.
abstract: OBJECTIVE
  This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets.
  
  
  BACKGROUND
  LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown.
  
  
  METHODS
  The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 +/- 12 years; ejection fraction: 65 +/- 10%) in whom LVESD was measured (36 +/- 7 mm).
  
  
  RESULTS
  Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus > or =40 mm (64 +/- 5% vs. 48 +/- 10%; p < 0.001, and 73 +/- 5% vs. 63 +/- 10%; p = 0.001). LVESD > or =40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD > or =40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD > or =40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death).
  
  
  CONCLUSIONS
  In MR due to flail leaflets, LVESD > or =40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD > or =40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.
authors.affiliation: Department of Cardiology, INSERM, ERI 12, and University Hospital, Amiens, France. tribouilloy.christophe@chu-amiens.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Jean François
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.forename: Marinella
authors.initials: M
authors.lastname: Ferlito
authors.forename: Laurence
authors.initials: L
authors.lastname: Tafanelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.forename: Faouzi
authors.initials: F
authors.lastname: Trojette
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Maria G
authors.initials: MG
authors.lastname: Modena
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D015150:Echocardiography, Doppler; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D009200:Myocardial Contraction / Q000502:physiology*; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*