PMID- 34505313
OWN - NLM
STAT- MEDLINE
DCOM- 20211206
LR  - 20211214
IS  - 1540-8175 (Electronic)
IS  - 0742-2822 (Linking)
VI  - 38
IP  - 9
DP  - 2021 Sep
TI  - Clinical impact of mitral regurgitation in aortic valve stenosis: Insight from 
      effective regurgitant orifice area.
PG  - 1604-1611
LID - 10.1111/echo.15184 [doi]
AB  - PURPOSE: Mechanisms leading to heart failure (HF) symptoms in aortic valve 
      stenosis (AS) are contentious. We examined the impact of secondary mitral 
      regurgitation (MR) on the symptomatic status in patients with AS. METHODS: 
      Outpatients performing echocardiography with any degree of AS, without organic 
      mitral valve disease, mitral valve intervention, or aortic insufficiency were 
      enrolled. MR was quantitatively defined through mitral effective regurgitant 
      orifice area (EROA) using the proximal isovelocity surface area method. Patients 
      were divided into two groups (New York Heart Association [NYHA] class I-II vs. 
      NYHA class III-IV). RESULTS: Five hundred and eighty-four patients were enrolled 
      (484 NYHA I-II, 100 NYHA III-IV). More symptomatic patients had smaller aortic 
      valve area (AVA), lower left ventricular ejection fraction (LVEF) and stroke 
      volume, higher E/E', and LV global afterload. MR was present in 178 (30%) 
      patients and EROA was <.20 cm(2) in 158 (89%). NYHA III-IV patients showed higher 
      prevalence of MR (78% vs 21%, P < 0.0001) and larger EROA (.13+/-.08 cm(2) vs 
      .09+/-.07 cm(2) , P < 0.0001). An association between EROA and symptoms was present 
      in the total cohort and in subgroups with preserved LVEF, AVA >/= 1 and <1 cm(2) , 
      EE' 8-14 and >/=14 (P < 0.05 for all). EROA was associated with severe symptoms 
      after adjustment for LVEF, E/E', and AVA in the overall population (OR 1.10 
      [1.06-1.15]; P < 0.0001) and in the 516 patients with preserved LVEF (OR 1.13 
      [1.08-1.19]; P < 0.0001). CONCLUSION: In patients with AS, greater EROA values 
      are associated with HF symptoms, even though MR degree is far from the threshold 
      of MR severity. Therefore, even a mild MR represents a supportive marker of HF 
      symptoms presence.
CI  - (c) 2021 Wiley Periodicals LLC.
FAU - Maffeis, Caterina
AU  - Maffeis C
AUID- ORCID: 0000-0002-5667-1175
AD  - Department of Medicine, Section of Cardiology, University of Verona, Verona, 
      Italy.
FAU - Benfari, Giovanni
AU  - Benfari G
AD  - Department of Medicine, Section of Cardiology, University of Verona, Verona, 
      Italy.
FAU - Nistri, Stefano
AU  - Nistri S
AD  - Cardiology Service, Centro Medico Strumentale Riabilitativo Veneto Medica, 
      Altavilla Vicentina, Italy.
FAU - Ribichini, Flavio L
AU  - Ribichini FL
AD  - Department of Medicine, Section of Cardiology, University of Verona, Verona, 
      Italy.
FAU - Rossi, Andrea
AU  - Rossi A
AUID- ORCID: 0000-0001-7095-7121
AD  - Department of Medicine, Section of Cardiology, University of Verona, Verona, 
      Italy.
LA  - eng
PT  - Journal Article
DEP - 20210909
PL  - United States
TA  - Echocardiography
JT  - Echocardiography (Mount Kisco, N.Y.)
JID - 8511187
SB  - IM
MH  - *Aortic Valve Stenosis/complications/diagnostic imaging
MH  - Humans
MH  - Mitral Valve
MH  - *Mitral Valve Insufficiency/complications/diagnostic imaging
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - aortic valve stenosis
OT  - echocardiography
OT  - heart failure
OT  - mitral regurgitation
EDAT- 2021/09/11 06:00
MHDA- 2021/12/15 06:00
CRDT- 2021/09/10 07:18
PHST- 2021/06/27 00:00 [revised]
PHST- 2021/03/21 00:00 [received]
PHST- 2021/08/09 00:00 [accepted]
PHST- 2021/09/11 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/09/10 07:18 [entrez]
AID - 10.1111/echo.15184 [doi]
PST - ppublish
SO  - Echocardiography. 2021 Sep;38(9):1604-1611. doi: 10.1111/echo.15184. Epub 2021 
      Sep 9.