PMID- 27339493
OWN - NLM
STAT- MEDLINE
DCOM- 20170626
LR  - 20220321
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 67
IP  - 25
DP  - 2016 Jun 28
TI  - Effect of Pulmonary Vascular Pressures on Long-Term Outcome in Patients With 
      Primary Mitral Regurgitation.
PG  - 2952-61
LID - S0735-1097(16)32910-2 [pii]
LID - 10.1016/j.jacc.2016.03.589 [doi]
AB  - BACKGROUND: Primary mitral regurgitation (MR) is a growing health problem due to 
      the aging population. OBJECTIVES: The purpose of this study was to assess the 
      impact of baseline pulmonary hypertension on long-term outcomes in patients with 
      significant primary MR and preserved left ventricular ejection fraction (LVEF). 
      METHODS: We studied 1,318 patients with >/=3+ primary MR and LVEF >/=60% using 
      echocardiography at rest; they were evaluated at our center from 2005 to 2008. 
      Baseline clinical and echocardiography data were recorded, and the Society of 
      Thoracic Surgeons (STS) score was calculated. The primary outcome was death. 
      RESULTS: Mean STS score was 3.98 +/- 1%; 54% of patients were in New York Heart 
      Association (NYHA) functional class I and 31% were in NYHA functional class II; 
      and 18% had atrial fibrillation (AF). Mean LVEF, mitral effective regurgitant 
      orifice, indexed LV end-systolic diameter (LVESD), and right ventricular systolic 
      pressure (RVSP) were 62 +/- 2%, 0.56 +/- 0.30 cm(2), 1.6 +/- 0.3 cm/m(2), and 37 +/- 14 
      mm Hg, respectively. At 7.1 +/- 2.0 years, 86% had mitral valve (MV) surgery. Death 
      occurred in 130 (10%) patients. On Cox multivariable analysis, baseline RVSP, 
      together with age, baseline NYHA functional class, pre-operative AF, coronary 
      artery disease, and indexed LVESD were associated with a higher rate of longer 
      term mortality (all p < 0.01), whereas MV surgery (as a time-dependent covariate) 
      was associated with improved survival (p < 0.001). Addition of RVSP to the STS 
      score significantly reclassified the risk for longer term mortality (integrated 
      discrimination index: 0.07; p < 0.001); 77% patients who died had RVSP >/=35 mm Hg. 
      CONCLUSIONS: In patients with significant primary MR and preserved LVEF, baseline 
      RVSP is independently associated with long-term survival. Impact of RVSP is 
      progressive and not confined to those with the highest baseline values.
CI  - Copyright (c) 2016 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Mentias, Amgad
AU  - Mentias A
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Patel, Krishna
AU  - Patel K
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Patel, Harsh
AU  - Patel H
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Gillinov, A Marc
AU  - Gillinov AM
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Sabik, Joseph F
AU  - Sabik JF
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Mihaljevic, Tomislav
AU  - Mihaljevic T
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Suri, Rakesh M
AU  - Suri RM
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Rodriguez, L Leonardo
AU  - Rodriguez LL
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Svensson, Lars G
AU  - Svensson LG
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Griffin, Brian P
AU  - Griffin BP
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Desai, Milind Y
AU  - Desai MY
AD  - Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 
      Electronic address: desaim2@ccf.org.
LA  - eng
PT  - Journal Article
PT  - Observational Study
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. 2016 Jun 28;67(25):2962-4. PMID: 27339494
CIN - Ann Transl Med. 2016 Dec;4(24):498. PMID: 28149860
CIN - Ann Transl Med. 2016 Dec;4(24):541. PMID: 28149902
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/*etiology/physiopathology
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/*complications/mortality/physiopathology/surgery
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - preserved ejection fraction
OT  - pulmonary hypertension
OT  - right ventricular systolic pressure
OT  - risk stratification
EDAT- 2016/06/25 06:00
MHDA- 2017/06/27 06:00
CRDT- 2016/06/25 06:00
PHST- 2016/03/17 00:00 [received]
PHST- 2016/03/29 00:00 [accepted]
PHST- 2016/06/25 06:00 [entrez]
PHST- 2016/06/25 06:00 [pubmed]
PHST- 2017/06/27 06:00 [medline]
AID - S0735-1097(16)32910-2 [pii]
AID - 10.1016/j.jacc.2016.03.589 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2016 Jun 28;67(25):2952-61. doi: 10.1016/j.jacc.2016.03.589.