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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
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Long-term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets: a
Christophe Tribouilloy1, Dan Rusinaru, Francesco Grigioni
1Department of Cardiology, University Hospital Amiens, Amiens, France.
Circulation. Cardiovascular Imaging
|December 24, 2013
Summary
Ejection fraction (EF) is crucial for assessing left ventricular (LV) dysfunction in mitral regurgitation. Lower EF (<45%) indicates severe dysfunction with high mortality, necessitating surgery for better outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Ejection fraction (EF) thresholds for diagnosing left ventricular (LV) dysfunction in mitral regurgitation (MR) lack clear definition and consistent clinical application.
- Existing guidelines for LV dysfunction severity in MR are debated, leading to potential underdiagnosis or delayed treatment.
Purpose of the Study:
- To objectively establish EF thresholds for various degrees of LV dysfunction in organic mitral regurgitation.
- To assess the prognostic value of EF in a large cohort of patients with MR.
- To determine the benefit of mitral surgery in patients with different EF levels.
Main Methods:
- Analysis of 1875 patients with organic mitral regurgitation from the Mitral Regurgitation International Database (MIDA) registry.
- Investigated the relationship between EF and all-cause mortality.
- Compared outcomes between medical management and surgical intervention based on EF.
Main Results:
- Mortality significantly increased with EF <60% under medical management (aHR, 1.59) and overall (aHR, 1.51).
- EF <45% identified severe LV dysfunction, associated with a 2.43-fold higher mortality risk under medical management.
- Mitral surgery provided considerable survival benefit in patients with EF <45% (aHR, 0.28) and EF 45%-60% (aHR, 0.34).
Conclusions:
- EF is a valuable marker for assessing LV dysfunction severity in organic mitral regurgitation.
- Patients with EF <45% have severe LV dysfunction and poor outcomes with medical management, warranting surgical consideration.
- Prompt surgical referral is critical for patients with EF <60% due to increased mortality risk.
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