title: Echo-Doppler determinants of outcomes in patients with unoperated significant mitral regurgitation in current era.
abstract: One-half of patients with severe symptomatic mitral regurgitation (MR) do not undergo surgery due to comorbidities. We evaluated prognosticators of outcomes in patients with unoperated significant MR.
  
  
  
  In this observational study, we retrospectively evaluated medical records of 75 consecutive patients with unoperated significant MR.
  
  
  
  All-cause mortality was 39% at 5 years. Non-survivors (n=29) versus survivors (n=46) were: older (77±9.8 vs 68±14, p=0.006), had higher New York Heart Association (NYHA) class (2.7±0.8 vs 2.3±0.8, p=0.037), higher brain natriuretic peptide (1157±717 vs 427±502 pg/mL, p=0.024, n=18), more coronary artery disease (61% vs 35%, p=0.031), more frequent left ventricular ejection fraction <50% (20.7% vs 4.3%, p=0.026), more functional MR (41% vs 22%, p=0.069), higher mitral E/E(') (12.7±4.6 vs 9.8±4, p=0.008), higher pulmonary artery systolic pressure (PASP; 52.6±18.7 vs 36.7±14, p <0.001), more ≥3+ tricuspid regurgitation (28% vs 4%, p=0.005) and more right ventricular dysfunction (26% vs 6%, p=0.035). Significant predictors of 5-year mortality were PASP (p=0.001) and E/E(') (p=0.011) using multivariate regression analysis.
  
  
  
  Patients with unoperated significant MR have high mortality. Elevated PASP and mitral E/E(') were the most significant predictors of 5-year survival in patients with unoperated significant MR. Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines provide a limited incorporation of echo-Doppler parameters in the preoperative risk stratification of patients with severe MR.
authors.affiliation: UCLA Medical Center , Los Angeles, California , USA.
authors.forename: Asim M
authors.initials: AM
authors.lastname: Rafique
authors.affiliation: Cedars-Sinai Heart Institute , Los Angeles, California , USA.
authors.forename: Parham
authors.initials: P
authors.lastname: Zarrini
authors.affiliation: University of Arizona , Tucson, Arizona , USA.
authors.forename: Nirmal
authors.initials: N
authors.lastname: Singh
authors.affiliation: Sheba-Tel Hashomer Hospital , Ramat Gan , Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.affiliation: UCLA Medical Center , Los Angeles, California , USA.
authors.forename: Rigved
authors.initials: R
authors.lastname: Tadwalkar
authors.affiliation: UPMC Presbyterian , Pittsburgh, Pennsylvania , USA.
authors.forename: Meshe
authors.initials: M
authors.lastname: Chonde
authors.affiliation: Cedars-Sinai Heart Institute , Los Angeles, California , USA.
authors.forename: Leandro
authors.initials: L
authors.lastname: Slipczuk
authors.affiliation: Cedars-Sinai Heart Institute , Los Angeles, California , USA.
authors.forename: Bojan
authors.initials: B
authors.lastname: Cercek
authors.affiliation: Cedars-Sinai Heart Institute , Los Angeles, California , USA.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: Cedars-Sinai Heart Institute , Los Angeles, California , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
keywords: HEART FAILURE