RT Journal Article
SR Electronic
T1 Prognostic impact of peak mitral inflow velocity in asymptomatic degenerative mitral regurgitation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 609
OP 615
DO 10.1136/heartjnl-2018-313733
VO 105
IS 8
A1 Chisato Okamoto
A1 Atsushi Okada
A1 Hideaki Kanzaki
A1 Kunihiro Nishimura
A1 Yasuhiro Hamatani
A1 Masashi Amano
A1 Hiroyuki Takahama
A1 Makoto Amaki
A1 Takuya Hasegawa
A1 Tomoyuki Fujita
A1 Junjiro Kobayashi
A1 Satoshi Yasuda
A1 Chisato Izumi
YR 2019
UL http://heart.bmj.com/content/105/8/609.abstract
AB 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.