title: Early mitral valve repair versus watchful waiting in patients with severe asymptomatic organic mitral regurgitation; rationale and design of the Dutch AMR trial, a multicenter, randomised trial.
abstract: BACKGROUND
  Asymptomatic severe mitral valve (MV) regurgitation with preserved left ventricular function is a challenging clinical entity as data on the recommended treatment strategy for these patients are scarce and conflicting. For asymptomatic patients, no randomised trial has been performed for objectivising the best treatment strategy.
  
  
  METHODS
  The Dutch AMR (Asymptomatic Mitral Regurgitation) trial is a multicenter, prospective, randomised trial comparing early MV repair versus watchful waiting in asymptomatic patients with severe organic MV regurgitation. A total of 250 asymptomatic patients (18-70 years) with preserved left ventricular function will be included. Intervention will be either watchful waiting or MV surgery. Follow-up will be 5 years. Primary outcome measures are all-cause mortality and a composite endpoint of cardiovascular mortality, congestive heart failure, and hospitalisation for non-fatal cardiovascular and cerebrovascular events. Secondary outcome measures are total costs, cost-effectiveness, quality of life, echocardiographic and cardiac magnetic resonance parameters, exercise tests, asymptomatic atrial fibrillation and brain natriuretic peptide levels. Additionally, the complication rate in the surgery group and rate of surgery in the watchful waiting group will be determined.
  
  
  CONCLUSIONS
  The Dutch AMR trial will be the first multicenter randomised trial on this topic. We anticipate that the results of this study are highly needed to elucidate the best treatment strategy and that this may prove to be an international landmark study.
authors.affiliation: Department of Cardiology, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Tietge
authors.forename: L M
authors.initials: LM
authors.lastname: de Heer
authors.forename: M W J
authors.initials: MW
authors.lastname: van Hessen
authors.forename: R
authors.initials: R
authors.lastname: Jansen
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: W
authors.initials: W
authors.lastname: van Gilst
authors.forename: M
authors.initials: M
authors.lastname: Schalij
authors.forename: R J M
authors.initials: RJ
authors.lastname: Klautz
authors.forename: R B A
authors.initials: RB
authors.lastname: Van den Brink
authors.forename: L A
authors.initials: LA
authors.lastname: Van Herwerden
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: S A J
authors.initials: SA
authors.lastname: Chamuleau
authors.forename: J
authors.initials: J
authors.lastname: Kluin