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Valvular heart disease
Original research article
Prognostic impact of peak mitral inflow velocity in asymptomatic degenerative mitral regurgitation
  1. Chisato Okamoto1,
  2. Atsushi Okada1,
  3. Hideaki Kanzaki1,
  4. Kunihiro Nishimura2,
  5. Yasuhiro Hamatani1,
  6. Masashi Amano1,
  7. Hiroyuki Takahama1,
  8. Makoto Amaki1,
  9. Takuya Hasegawa1,
  10. Tomoyuki Fujita3,
  11. Junjiro Kobayashi3,
  12. Satoshi Yasuda1,
  13. Chisato Izumi1
  1. 1 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  2. 2 Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  3. 3 Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  1. Correspondence to Dr Atsushi Okada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan; okada.atsushi.hp{at}ncvc.go.jp

Abstract

Objective Appropriate timing of mitral valve surgery in asymptomatic mitral regurgitation (MR) remains controversial. Peak mitral inflow velocity (peak E wave velocity) has been reported as a simple and easy predictor of quantitative MR severity; however, its prognostic significance in asymptomatic MR remains unclear. Therefore, we sought to investigate the prognostic impact of peak E wave velocity in asymptomatic MR.

Methods Among 529 consecutive patients with degenerative MR of grade 3+ (moderate to severe) or 4+ (severe), 188 asymptomatic patients in sinus rhythm without left ventricular (LV) dysfunction (end-systolic dimension ≥40 mm or ejection fraction <60%) or pulmonary hypertension were studied. Cardiovascular events were defined as a composite endpoint of cardiovascular death or events that indicated mitral surgery including congestive heart failure, atrial fibrillation, LV dysfunction or pulmonary hypertension.

Results Average peak E wave velocity was 1.05±0.26 m/s, and was significantly higher in grade 4+ than grade 3+ (1.20±0.28 vs 0.98±0.21 m/s, p<0.001). Peak E wave velocity was associated with quantitative MR severity, as well as clinical characteristics of advanced MR (higher brain natriuretic peptide, larger LV and left atrium, higher tricuspid regurgitation pressure gradient and dilated inferior vena cava). During a median follow-up of 4.3 years, 66 (35%) patients developed cardiovascular events. Multivariate Cox proportional hazards analysis showed that peak E wave velocity was an independent predictor of cardiovascular events (adjusted HR 1.245 (95% CI 1.126 to 1.378) per 0.1 m/s, p<0.001).

Conclusions Peak E wave velocity was an independent predictor of cardiovascular events in asymptomatic degenerative MR with preserved LV function.

  • mitral regurgitation
  • echocardiography
  • valvular heart disease
  • valve disease surgery

https://doi.org/10.1136/heartjnl-2018-313733

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    Footnotes

    • Contributors Substantial contribution to conception and design: CO, AO, HK, YH, MA, HT, MA, TH, SY and CI. Collection of data: CO, AO, HK, YH, MA, HT, MA, TH and CI. Analysis and interpretation of data: CO, AO, HK, KN, TF, JK, SY and CI. All authors have given critical review of the article and approved the final version of the manuscript submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Institutional Review Board of National Cerebral and Cardiovascular Center (M29-061).

    • Provenance and peer review Not commissioned; externally peer reviewed.