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1. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

Author

Francesco Grigioni, Giovanni Benfari, Jean-Louis Vanoverschelde, Christophe Tribouilloy, Jean-Francois Avierinos, Francesca Bursi, Rakesh M. Suri, Federico Guerra, Agnés Pasquet, Dan Rusinaru, Emanuela Marcelli, Alexis Théron, Andrea Barbieri, Hector Michelena, Siham Lazam, Catherine Szymanski, Vuyisile T. Nkomo, Alessandro Capucci, Prabin Thapa, Maurice Enriquez-Sarano, R. Suri, M.A Clavel, J. Maalouf, H. Michelena, M. Enriquez-Sarano, C. Tribouilloy, F. Trojette, C. Szymanski, D. Rusinaru, G. Touati, J.P. Remadi, F. Guerra, A. Capucci, F. Grigioni, A. Russo, E. Biagini, F. Pasquale, M. Ferlito, C. Rapezzi, C. Savini, G. Marinelli, D. Pacini, G.D. Gargiulo, R. Di Bartolomeo, J. Boulif, C. de Meester, G. El Khoury, B. Gerber, S. Lazam, A. Pasquet, P. Noirhomme, D. Vancraeynest, J-L. Vanoverschelde, J.F. Avierinos, F. Collard, A. Théron, G. Habib, A. Barbieri, F. Bursi, F. Mantovani, R. Lugli, M.G. Modena, G. Boriani, L. Bacchi-Reggiani, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, University of Balamand [Liban] (UOB), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Grigioni, Francesco, Benfari, Giovanni, Vanoverschelde, Jean-Loui, Tribouilloy, Christophe, Avierinos, Jean-Francoi, Bursi, Francesca, Suri, Rakesh M., Guerra, Federico, Pasquet, Agné, Rusinaru, Dan, Marcelli, Emanuela, Théron, Alexi, Barbieri, Andrea, Michelena, Hector, Lazam, Siham, Szymanski, Catherine, Nkomo, Vuyisile T., Capucci, Alessandro, Thapa, Prabin, Enriquez-Sarano, Maurice, Suri, R., Clavel, M.A., Maalouf, J., Michelena, H., Enriquez-Sarano, M., Tribouilloy, C., Trojette, F., Szymanski, C., Rusinaru, D., Touati, G., Remadi, J.P., Guerra, F., Capucci, A., Grigioni, F., Russo, A., Biagini, E., Pasquale, F., Ferlito, M., Rapezzi, C., Savini, C., Marinelli, G., Pacini, D., Gargiulo, G.D., Di Bartolomeo, R., Boulif, J., de Meester, C., El Khoury, G., Gerber, B., Lazam, S., Pasquet, A., Noirhomme, P., Vancraeynest, D., Vanoverschelde, J.-L., Avierinos, J.F., Collard, F., Théron, A., Habib, G., Barbieri, A., Bursi, F., Mantovani, F., Lugli, R., Modena, M.G., Boriani, G., Bacchi-Reggiani, L., University of Balamand - UOB (LIBAN), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire

Subjects
Male, atrial fibrillation, mitral regurgitation, mitral repair, percutaneous treatment, prognosis, surgery, Aged, Aged, 80 and over, Atrial Fibrillation, Cohort Studies, Female, Humans, Middle Aged, Mitral Valve Insufficiency, Prevalence, Registries, Cardiology and Cardiovascular Medicine, 030204 cardiovascular system & hematology, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Sinus rhythm, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Ejection fraction, Mitral repair, Absolute risk reduction, Atrial fibrillation, Prognosis, 3. Good health, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Cardiology, medicine.symptom, prognosi, medicine.medical_specialty, Asymptomatic, Article, NO, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, International database, Internal medicine, medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, In patient, Mitral regurgitation, business.industry, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, business, Percutaneous treatment
Abstract

BACKGROUND: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. OBJECTIVES: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. METHODS: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. RESULTS: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values

Published
2019
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2. The MIDA Mortality Risk Score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation

Author

Hector I. Michelena, Mida Investigators, Rakesh M. Suri, Francesco Grigioni, Letizia Bacchi-Reggiani, Alexis Theron, Gaetano Gargiulo, Vuyisile T. Nkomo, Marie-Annick Clavel, Siham Lazam, Martin Schumacher, Jean-François Avierinos, Andrea Barbieri, Jean-Louis Vanoverschelde, Maurice Enriquez-Sarano, Agnes Pasquet, Catherine Szymanski, Pablo Oberti, Christophe Tribouilloy, Rodolfo Pizarro, Marianne Huebner, Dan Rusinaru, Francesca Bursi, DIPARTIMENTO DI MEDICINA SPECIALISTICA, DIAGNOSTICA E SPERIMENTALE, Facolta' di MEDICINA e CHIRURGIA, AREA MIN. 06 - Scienze mediche, Grigioni, Francesco, Clavel, Marie-Annick, Vanoverschelde, Jean-Loui, Tribouilloy, Christophe, Pizarro, Rodolfo, Huebner, Marianne, Avierinos, Jean-Francoi, Barbieri, Andrea, Suri, Rakesh, Pasquet, Agné, Rusinaru, Dan, Gargiulo, Gaetano D, Oberti, Pablo, Théron, Alexi, Bursi, Francesca, Michelena, Hector, Lazam, Siham, Szymanski, Catherine, Nkomo, Vuyisile T, Schumacher, Martin, Bacchi-Reggiani, Letizia, Enriquez-Sarano, Maurice, University of Bologna/Università di Bologna, Mayo Clinic [Rochester], Pôle d’Imagerie Médicale, Radiothérapie et Oncologie (MIRO), Université Catholique de Louvain = Catholic University of Louvain (UCL), Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Division of Cardiology, Cliniques Universitaires Saint-Luc [Bruxelles], CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Assistance Publique - Hôpitaux de Marseille (APHM), IRPPS-CNR, Salerno, Università degli Studi di Salerno = University of Salerno (UNISA), Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Cardiologie [Amiens], Aix Marseille Université (AMU), Mayo Clinic [Rochester, MN, USA], and MIDA Investigators: C Tribouilloy, F Trojette, C Szymanski, D Rusinaru, G Touati, J P Remadi, F Grigioni, A Russo, E Biagini, F Pasquale, M Ferlito, C Rapezzi, C Savini, G Marinelli, D Pacini, G D Gargiulo, R Di Bartolomeo, I Corazza, P Oberti, R Pizarro, J Boulif, C de Meester, G El Khoury, B Gerber, S Lazam, A Pasquet, P Noirhomme, D Vancraeynest, J-L Vanoverschelde, J F Avierinos, F Collard, A Théron, G Habib, A Barbieri, F Bursi, F Mantovani, R Lugli, M G Modena, G Boriani, M A Clavel, J Maalouf, H Michelena, Vuyisile T Nkomo, M Enriquez-Sarano, R Suri, L Bacchi-Reggiani, M Schumacher, M Huebner

Subjects
Male, medicine.medical_specialty, Databases, Factual, Prognosi, [SDV]Life Sciences [q-bio], Concordance, Population, Clinical Decision-Making, MEDLINE, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, Atrial Fibrillation, medicine, Humans, 030212 general & internal medicine, Registries, education, Mitral regurgitation, Aged, education.field_of_study, Framingham Risk Score, business.industry, Mitral repair, Mitral Valve Insufficiency, Percutaneous mitral repair, Percutaneous mitral replacement, Prognosis, Surgery, Middle Aged, Clinical trial, Echocardiography, Predictive value of tests, embryonic structures, Cohort, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

International audience; Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 +/- 14 years; 70% males; follow-up 7.8 +/- 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 +/- 1, 57 +/- 4, and 21 +/- 10% under medical management and 99 +/- 1, 82 +/- 2, and 57 +/- 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P

Published
2016
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