title: Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation.
abstract: OBJECTIVE
  The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die.
  
  
  METHODS
  Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity.
  
  
  RESULTS
  Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82.
  
  
  CONCLUSIONS
  The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Mass.
authors.forename: Judy
authors.initials: J
authors.lastname: Hung
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Overbey
authors.affiliation: Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Annetine.gelijns@mountsinai.edu.
authors.forename: Annetine C
authors.initials: AC
authors.lastname: Gelijns
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.affiliation: Institut Universitaire de Cardiologie de Quebec, Hopital Laval, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: O'Gara
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Michler
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Marc
authors.initials: M
authors.lastname: Gillinov
authors.affiliation: Department of Cardiac Surgery, Mount Sinai Beth Israel, Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Division of Cardiac Surgery, University of Maryland, Baltimore, Md.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.affiliation: Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, Tex.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, NC.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.affiliation: Cardiac Surgery, The Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Chittoor
authors.initials: C
authors.lastname: Sai-Sudhakar
authors.affiliation: Center for Heart & Vascular Health, Christiana Care Health System, Newark, Del.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Gardner
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: Division of Cardiology, Massachusetts General Hospital, Boston, Mass.
authors.forename: Xin
authors.initials: X
authors.lastname: Zeng
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Karen
authors.initials: K
authors.lastname: O'Sullivan
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Parides
authors.affiliation: Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
authors.forename: Roger
authors.initials: R
authors.lastname: Swayze
authors.affiliation: Department of Cardiac Surgery, Mount Sinai Beth Israel, Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR) in the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Rose
authors.affiliation: Montréal Heart Institute, University of Montréal, Montréal, Québec, Canada.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002170:Canada; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018618:Echocardiography, Doppler, Color; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States