Acar L, Behrendt C A, Baldus S, Falk V, Smetak N, Nzomo M Mboulla, Marschall U, Girdauskas E
BARMER, Wuppertal, Germany.
Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany.
Clin Res Cardiol. 2024 Aug 28. doi: 10.1007/s00392-024-02532-0.
The impact of mitral regurgitation (MR) in asymptomatic patients is not well defined. We aimed to determine the prevalence of MR-related complications and their association with 10-year survival in a large unselected asymptomatic MR cohort.
Health insurance claims data from Germany's second largest health insurance fund, BARMER, which maintains longitudinal data on 8.7 million German residents, were retrospectively analyzed. All patients with an outpatient diagnosis of MR in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011 were included. Patients with any complication attributable to MR or mitral valve intervention at index were excluded. Outcomes were compared between study group and age- and sex-matched controls (i.e., without known cardiac disease). MR-related complications of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation.
A total of 56,577 individuals (median age 68 years, 67% female) with asymptomatic MR were identified. At 10 years, MR-related complications were more frequent in the study group vs. control group (46.5% vs. 20.8%, OR 3.31, P < 0.0001). Furthermore, MR-related complications were more common in male vs. female patients with an asymptomatic MR (OR 2.65, P < 0.0001). The occurrence of at least one MR-related complication was associated with a reduced 10-year survival (OR 1.80, P < 0.0001).
Almost half of patients with asymptomatic MR experience complications during a 10 year follow-up which result in impaired survival. These results imply the necessity of long-term disease management program. Furthermore, decision-making process and timing for mitral valve intervention in asymptomatic patients should be reevaluated.
二尖瓣反流（MR）对无症状患者的影响尚不明确。我们旨在确定大型未选择的无症状MR队列中MR相关并发症的患病率及其与10年生存率的关联。
回顾性分析了德国第二大健康保险基金BARMER的健康保险理赔数据，该基金保存了870万德国居民的纵向数据。纳入在一个日历年中至少两个季度门诊诊断为MR且2008年至2011年首次记录诊断的所有患者。排除索引时任何归因于MR或二尖瓣干预的并发症患者。将研究组与年龄和性别匹配的对照组（即无已知心脏病）的结果进行比较。感兴趣的MR相关并发症为新发充血性心力衰竭、新发房颤、肺动脉高压或心脏失代偿。
共识别出56577例无症状MR患者（中位年龄68岁，67%为女性）。10年后，研究组中MR相关并发症比对照组更常见（46.5%对20.8%，OR 3.31，P＜0.0001）。此外，无症状MR男性患者中MR相关并发症比女性更常见（OR 2.65，P＜0.0001）。至少发生一种MR相关并发症与10年生存率降低相关（OR 1.80，P＜0.0001）。
几乎一半的无症状MR患者在10年随访期间出现并发症，导致生存率受损。这些结果意味着需要长期疾病管理计划。此外，应重新评估无症状患者二尖瓣干预的决策过程和时机。
