JACC March 17, 2015 Volume 65, Issue 10S Valvular Heart ... · Authors: Harsh Patel, Krishna Patel,...

Valvular Heart Disease

A1954JACC March 17, 2015Volume 65, Issue 10S

imPAct of BAseline PulmonAry Pressures on long-term outcome in myxomAtous mitrAl regurgitAtion: thresholD or Progressive effect?

Moderated Poster ContributionsValvular Heart Disease Moderated Poster Theater, Poster Hall B1Saturday, March 14, 2015, 4:00 p.m.-4:10 p.m.

Session Title: Predictions and Prognosis for Organic MRAbstract Category: 40. Valvular Heart Disease: ClinicalPresentation Number: 1170M-05

Authors: Harsh Patel, Krishna Patel, Amgad Mentias, A. Gillinov, Richard Grimm, L. Leonardo Rodriguez, Tomislav Mihaljevic, Joseph Sabik, Brian Griffin, Milind Desai, Cleveland Clinic Foundation, Cleveland, OH, USABackground: We sought to assess impact of pulmonary hypertension on long-term outcomes in patients with significant myxomatous mitral regurgitation (MMR).methods: We studied 1318 patients (age 62±13 years & 66% men) with ≥3+ MMR on resting echo, evaluated at our center from 2005-8. Baseline clinical & echo data were recorded & Society of Thoracic Surgeons (STS) score was calculated. Outcome was cardiac death.results: Mean STS score was 3.98±1%. 49% were in functional class (FC) I &35% in FC II; 18% had atrial fibrillation (AF). Mean left ventricular ejection fraction (LVEF), mitral effective regurgitant orifice, indexed LV end-systolic diameter (LVESD) & right ventricular systolic pressure (RVSP) were 60±4%, 0.50±0.3 cm2, 1.6±0.3 cm/m2 & 37±14 mm Hg; 44% had flail. At 7.1±2 years, 86% had MV surgery (92% repair; 13%, concomitant coronary bypass). Death occurred in 112 (9%) patients (30-day post-operative death & stroke were 0 & 2%). On stepwise Cox multivariable analysis, baseline RVSP (HR 1.48, figure), along with STS score (HR 1.36), mitral surgery (time-dependent covariate, HR 0.34), indexed LVESD (HR 0.63) & AF (HR 1.68) predicted death (all p<0.01). Addition of RVSP to STS improved net reclassification (0.65 [0.46-0.84], p<0001); 88% patients that died had RVSP≥35 mmHg.conclusion: Although RVSP often decreases & even normalizes after mitral surgery in MMR, baseline RVSP is independently predicts long-term survival. Impact of RVSP is progressive & not confined to those with highest baseline values.