Back to Search
Start Over
Prognostic impact of invasive exercise haemodynamics in patients with severe mitral regurgitation
- Source :
- European Journal of Cardio-Thoracic Surgery. 61:657-665
- Publication Year :
- 2021
- Publisher :
- Oxford University Press (OUP), 2021.
-
Abstract
- OBJECTIVES Abnormal invasive exercise haemodynamics in asymptomatic patients with severe mitral regurgitation were associated with higher regurgitation burden. We analysed the association between parameters of invasive exercise testing with mortality and valve surgery compared to guideline defined non-invasive criteria. METHODS This single centre, retrospective cohort study assesses the association of invasive exercise haemodynamics and mortality with and without surgery in patients with severe mitral regurgitation and normal ejection fraction (≥55%) as primary outcome. The secondary outcome was the need for mitral valve surgery in 113 asymptomatic patients primarily managed conservatively. RESULTS We identified 314 patients [age 59 years (standard deviation 13), 27% female] with available exercise haemodynamics with a median follow-up of 8.2 (interquartile range 5.2–11.2) years. Five-year survival rate was 93.0%. Pulmonary capillary wedge pressure at maximum exercise >30 mmHg was the only parameter independently associated with mortality after adjustment for age and guideline criteria [hazard ratio (HR) 2.7 (1.3–5.6), P = 0.007]. In the 113 patients primarily managed conservatively, maximum pulmonary capillary wedge pressure was independently associated with mitral valve surgery during follow-up in multivariable analysis (HR 2.10 (1.32–3.34), P = 0.002; after adjustment for workload and weight: HR 1.31 (1.14–1.52), P 25 mmHg improved the predictive power of current guideline criteria for surgery (area under the curve 0.61–0.68, P = 0.02). CONCLUSIONS Invasive exercise haemodynamics predict mortality and improve prognostic information about surgery during follow-up derived from current guideline criteria in asymptomatic patients with severe mitral regurgitation.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Asymptomatic
Interquartile range
Internal medicine
medicine
Humans
Pulmonary Wedge Pressure
Pulmonary wedge pressure
Retrospective Studies
Mitral regurgitation
Ejection fraction
business.industry
Hazard ratio
Hemodynamics
Mitral Valve Insufficiency
General Medicine
Guideline
Middle Aged
Prognosis
medicine.disease
Cardiology
Female
Surgery
medicine.symptom
Cardiology and Cardiovascular Medicine
Mitral valve regurgitation
business
Subjects
Details
- ISSN :
- 1873734X and 10107940
- Volume :
- 61
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....12ff9d0bc4900d0c35d76481c7a4cd6c