Valvular Heart Disease A1954 JACC March 17, 2015 Volume 65, Issue 10S imPAct of BAseline PulmonAry Pressures on long-term outcome in myxomAtous mitrAl regurgitAtion: thresholD or Progressive effect? Moderated Poster Contributions Valvular Heart Disease Moderated Poster Theater, Poster Hall B1 Saturday, March 14, 2015, 4:00 p.m.-4:10 p.m. Session Title: Predictions and Prognosis for Organic MR Abstract Category: 40. Valvular Heart Disease: Clinical Presentation 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, USA Background: 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.

JACC March 17, 2015 Volume 65, Issue 10S Valvular Heart ... · Authors: Harsh Patel, Krishna Patel, Amgad Mentias, A. Gillinov, Richard Grimm, L. Leonardo Rodriguez, Tomislav Mihaljevic,

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Page 1: JACC March 17, 2015 Volume 65, Issue 10S Valvular Heart ... · Authors: Harsh Patel, Krishna Patel, Amgad Mentias, A. Gillinov, Richard Grimm, L. Leonardo Rodriguez, Tomislav Mihaljevic,

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.