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Heartbeat: not all patients with primary mitral regurgitation are the same
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}uw.edu

https://doi.org/10.1136/heartjnl-2023-322427

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    Management of patients with mitral valve regurgitation (MR) is quite different when valve dysfunction is due to a primary abnormality of the valve apparatus versus when MR is secondary to left ventricular dilation and/or dysfunction. However, even among patients with primary MR, outcomes differ depending on the underlying cause of valve disease, patient age and sex, concurrent cardiac and non-cardiac conditions and the degree of end-organ damage due to long-standing MR. In this issue of Heart, Kwak and colleagues1 identified five distinct risk phenogroups in patients with primary MR undergoing mitral valve surgery (figure 1). These phenogroups were defined in a derivation cohort of 1629 MR patients and then validated in an additional 692 MR patients undergoing mitral valve surgery. At median follow-up of 6 years, cumulative survival ranged from 83.4% in high-risk older patients (group 5) to 98.5% in younger patients with few comorbidities (group 1).

    Figure 1

    Data-driven phenogrouping of patients with severe primary MR undergoing MV surgery. Patients with severe primary MR undergoing MV surgery from three tertiary university hospitals were analysed (n=2321; derivation cohort, n=1629 and validation cohort, n=692). The latent variable (c) is estimated based on the 15 observed variables (y) of demographics, laboratory, surgical and echocardiographic factors by the expectation–maximisation algorithm, whose nominal categories are defined as latent classes (=groups). Five distinct groups were identified by LCA from the derivation cohort: group 1, least comorbidities (n=517); group 2, men with LV enlargement (n=249); group 3, predominantly women and rheumatic MR (n=171); group 4, low-risk older patients (n=461); and group 5, high-risk older patients (n=231). The prevalence of eight major risk factors in each phenogroup is depicted as a radar plot. The lines of the innermost octagon indicate zero prevalence. The phenogrouping …

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    Footnotes

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    • 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.

    • Provenance and peer review Commissioned; internally peer reviewed.