Abstract
Background
Mild secondary mitral regurgitation (SMR) is considered clinically benign when left-ventricular
ejection fraction (LVEF) is preserved, but evidence on survival associated with mild
SMR in normal LVEF is limited.
Methods
We conducted a retrospective cohort study of patients who underwent echocardiography
in a health care network between 2013 and 2018. We compared the survival of 4 groups:
no valvular abnormalities (group 1), trace SMR with trace or mild tricuspid regurgitation
(TR) (group 2), mild SMR with trace or no TR (group 3), and mild SMR with mild TR
(group 4). A Cox proportional hazard model evaluated hazard of death in groups 2 to
4 compared with group 1, adjusting for demographics, comorbidities, and LVEF. The
same comparisons were repeated in a subgroup of patients with preserved LVEF.
Results
Among the 16,372 patients of mean age 61 (51 to 71) years and 48% women, there were
8132 (49.7%) group 1 patients, 1902 (11.6%) group 2 patients, 3017 (18.4%) group 3
patients, and 3321 (20.3%) group 4 patients. Compared with group 1, group 4 had significantly
increased adjusted hazard of death (hazard ratio [HR], 1.21; 95% confidence interval
[CI], 1.12-1.31; P < 0.001), whereas groups 2 and 3 did not show a significantly different hazard of
death. In those with preserved LVEF, the hazard was also significantly higher in group
4, compared with group 1 (HR, 1.14; 95% CI, 1.03-1.26; P = 0.013).
Conclusions
Mild SMR with mild TR, irrespective of LVEF, was associated with worse survival compared
with patients without any valvular abnormalities. Patients with mild SMR may require
closer monitoring, even with normal LVEF.
Résumé
Contexte
L'insuffisance mitrale secondaire (IMS) légère est considérée comme cliniquement bénigne
lorsque la fraction d'éjection ventriculaire gauche (FEVG) est préservée, mais les
données sur la survie associée à l'IMS légère en cas de FEVG normale demeurent limitées.
Méthodes
Nous avons mené une étude de cohorte rétrospective de patients ayant subi une échocardiographie
dans un réseau de soins entre 2013 et 2018. Nous avons comparé le taux de survie de
quatre groupes : aucune anomalie valvulaire (groupe 1), trace d'IMS avec insuffisance
tricuspidienne (IT) sous forme de trace ou bien légère (groupe 2), légère IMS avec
trace ou sans IT (groupe 3), et légère IMS avec légère IT (groupe 4). Un modèle à
risques proportionnels de Cox a évalué le risque de décès dans les groupes 2 à 4 par
rapport au groupe 1, en réalisant les ajustements pour les données démographiques,
les comorbidités et la FEVG. Les mêmes comparaisons ont été répétées dans un sous-groupe
de patients ayant une FEVG préservée.
Résultats
Parmi les 16 372 patients de 61 ans d'âge moyen (51 à 71) et 48 % de femmes, il y
avait 8 132 patients (49,7 %) dans le groupe 1, 1 902 patients (11,6 %) dans le groupe
2, 3 017 patients (18,4 %) dans le groupe 3, et 3 321 patients (20,3 %) dans le groupe
4. Par rapport au groupe 1, le groupe 4 présentait un risque ajusté de décès significativement
plus élevé (rapport des risques instantanés [RRI], 1,21; intervalle de confiance [IC]
à 95 %, 1,12-1,31; P < 0,001), tandis que les groupes 2 et 3 ne présentaient pas de risque de décès significativement
différent. Chez les patients dont la FEVG était préservée, le risque était également
significativement plus élevé dans le groupe 4 que dans le groupe 1 (RRI, 1,14; IC
à 95 %, 1,03-1,26; P = 0,013).
Conclusions
Une IMS légère avec une IT légère, indépendamment de la FEVG, était associé à une
survie plus faible par rapport aux patients sans aucune anomalie valvulaire. Les patients
présentant une IMS légère peuvent avoir besoin d'une surveillance plus étroite, même
avec une FEVG normale.
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Article info
Publication history
Published online: June 10, 2021
Accepted:
June 4,
2021
Received:
April 27,
2021
Footnotes
See editorial by Carabello, pages 1498–1499 of this issue.
See page 1520 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Mild Valvular Regurgitation: A Culprit in Cardiovascular Mortality or a Summons to Find the Culprit?Canadian Journal of CardiologyVol. 37Issue 10
- PreviewBoth the US and European valve guidelines focus on the need for mechanical intervention in severe valvular heart disease (VHD) where intervention may be life saving.1,2 Indeed, mechanical intervention is recommended in almost all cases of severe symptomatic disease and in asymptomatic patients with ventricular dysfunction. There are also many class 2 indications for intervention, even in severe asymptomatic disease with “normal” ventricular function. Given that our definitions of mild, moderate, and severe disease are primarily based on the association of outcome with that degree of severity, some patients simply do not obey the rules.
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