PMID- 10588227
OWN - NLM
STAT- MEDLINE
DCOM- 19991217
LR  - 20201216
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 34
IP  - 7
DP  - 1999 Dec
TI  - Sudden death in mitral regurgitation due to flail leaflet.
PG  - 2078-85
AB  - OBJECTIVES: We sought to assess the incidence and determinants of sudden death 
      (SUD) in mitral regurgitation due to flail leaflet (MR-FL). BACKGROUND: Sudden 
      death is a catastrophic complication of MR-FL. Its incidence and predictability 
      are undefined. METHODS: The occurrence of SUD was analyzed in 348 patients (age 
      67 +/- 12 years) with MR-FL diagnosed echocardiographically from 1980 through 
      1994. RESULTS: During a mean follow-up of 48 +/- 41 months, 99 deaths occurred 
      under medical treatment. Sudden death occurred in 25 patients, three of whom were 
      resuscitated. The sudden death rates at five and 10 years were 8.6 +/- 2% and 
      18.8 +/- 4%, respectively, and the linearized rate was 1.8% per year. By 
      multivariate analysis, the independent baseline predictors of SUD were New York 
      Heart Association (NYHA) functional class (p = 0.006), ejection fraction (p = 
      0.0001) and atrial fibrillation (p = 0.059). The yearly linearized rate of sudden 
      death was 1% in patients in functional class I, 3.1% in class II and 7.8% in 
      classes III and IV. However, of 25 patients who had SUD, at baseline, 10 (40%) 
      were in functional class I, 9 (36%) were in class II and only 6 (24%) in class 
      III or IV. In five patients (20%), no evidence of risk factors developed until 
      SUD. In patients with an ejection fraction > or =60% and sinus rhythm, the 
      linearized rate of SUD was not different in functional classes I and II (0.8% per 
      year). Surgical correction of MR (n = 186) was independently associated with a 
      reduced incidence of SUD (adjusted hazard ratio [95% confidence interval] 0.29 
      [0.11 to 0.72], p = 0.007). CONCLUSIONS: Sudden death is relatively common in 
      patients with MR-FL who are conservatively managed. Patients with severe 
      symptoms, atrial fibrillation and reduced systolic function are at higher risk, 
      but notable rates of SUD have been observed without these risk factors. 
      Correction of MR appears to be associated with a reduced incidence of SUD, 
      warranting early consideration of surgical repair.
FAU - Grigioni, F
AU  - Grigioni F
AD  - Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo 
      Foundation, Rochester, Minnesota, USA.
FAU - Enriquez-Sarano, M
AU  - Enriquez-Sarano M
FAU - Ling, L H
AU  - Ling LH
FAU - Bailey, K R
AU  - Bailey KR
FAU - Seward, J B
AU  - Seward JB
FAU - Tajik, A J
AU  - Tajik AJ
FAU - Frye, R L
AU  - Frye RL
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 1999 Dec;34(7):2086-7. PMID: 10588228
CIN - J Am Coll Cardiol. 2000 Nov 15;36(6):2014-5. PMID: 11092679
MH  - Aged
MH  - Aged, 80 and over
MH  - Death, Sudden, Cardiac/epidemiology/*etiology
MH  - Echocardiography, Doppler
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*abnormalities/diagnostic imaging
MH  - Mitral Valve Insufficiency/*complications/mortality/physiopathology
MH  - Prognosis
MH  - Retrospective Studies
MH  - Stroke Volume
EDAT- 1999/12/10 00:00
MHDA- 1999/12/10 00:01
CRDT- 1999/12/10 00:00
PHST- 1999/12/10 00:00 [pubmed]
PHST- 1999/12/10 00:01 [medline]
PHST- 1999/12/10 00:00 [entrez]
AID - S0735-1097(99)00474-X [pii]
AID - 10.1016/s0735-1097(99)00474-x [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 1999 Dec;34(7):2078-85. doi: 10.1016/s0735-1097(99)00474-x.