Bohbot Yohann, Essayagh Benjamin, Benfari Giovanni, Bax Jeroen J, Le Tourneau Thierry, Topilsky Yan, Antoine Clemence, Rusinaru Dan, Grigioni Francesco, Ajmone Marsan Nina, van Wijngaarden Aniek, Hochstadt Aviram, Roussel Jean Christian, Diouf Momar, Thapa Prabin, Michelena Hector I, Enriquez-Sarano Maurice, Tribouilloy Christophe
Department of Cardiology Amiens University Hospital Amiens France.
UR UPJV 7517 Jules Verne University of Picardie Amiens France.
J Am Heart Assoc. 2025 Jan 7;14(1):e036206. doi: 10.1161/JAHA.124.036206. Epub 2024 Dec 18.
The prevalence and impact of right ventricular dysfunction (RVD) in degenerative mitral regurgitation (DMR) is unknown. We aimed to determine whether RVD assessed by echocardiography in routine clinical practice is independently associated with mortality in patients with DMR.
We used data from the MIDA-Q (Mitral Regurgitation International DAtabase-Quantitative) registry, which included patients with isolated DMR due to mitral valve prolapse from January 2003 to January 2020 from 5 tertiary centers across North America, Europe, and the Middle East. A cohort of 2917 (mean age: 66 years, 70.8% male patients, follow-up: 5.2 [3.3-8.3] years) consecutive patients with severe DMR was included and long-term mortality was analyzed. RVD, identified in 426 (14.6%) patients, was associated with reduced 8-year survival (55%±3% versus 77%±1%; <0.001), overall and in all subgroups of patients, even after comprehensive adjustment including left ventricular dilatation and dysfunction, DMR severity, pulmonary pressures, and surgery (adjusted hazard ratio, 1.44 [95% CI, 1.17-1.77]; <0.001). This excess mortality was observed under medical management (adjusted hazard ratio, 1.57 [95% CI, 1.20-2.05]; =0.001) and after surgical correction of mitral regurgitation (adjusted hazard ratio, 1.45 [95% CI, 1.02-2.05]; =0.039). Patients with RVD undergoing surgery within 3 months of diagnosis experienced a better 8-year survival (73%±4% versus 43%±4%; <0.001), even after adjustment (adjusted hazard ratio, 0.44 [95% CI, 0.29-0.67]; <0.001) despite an increase of 1-month postoperative mortality (7.1% versus 0.5% for patients without RVD; <0.001).
RVD is observed in 14.6% of severe DMR and exhibits a powerful and independent association with excess mortality partially attenuated by mitral surgery. Therefore, assessment of right ventricular systolic function should be included in routine DMR evaluation and in the clinical decision-making process.
退行性二尖瓣反流（DMR）中右心室功能障碍（RVD）的患病率及影响尚不清楚。我们旨在确定在常规临床实践中通过超声心动图评估的RVD是否与DMR患者的死亡率独立相关。
我们使用了MIDA-Q（二尖瓣反流国际数据库-定量）注册研究的数据，该研究纳入了2003年1月至2020年1月期间来自北美、欧洲和中东5个三级中心的因二尖瓣脱垂导致孤立性DMR的患者。纳入了2917例（平均年龄：66岁，男性患者占70.8%，随访时间：5.2[3.3 - 8.3]年）连续的重度DMR患者，并分析其长期死亡率。在426例（14.6%）患者中发现了RVD，其与8年生存率降低相关（55%±3%对77%±1%；<0.001），在所有患者总体及各亚组中均如此，即使在进行包括左心室扩张和功能障碍、DMR严重程度、肺压力及手术等全面调整后也是如此（调整后风险比，1.44[95%CI，1.17 - 1.77]；<0.001）。在药物治疗（调整后风险比，1.57[95%CI，1.20 - 2.05]；=0.001）及二尖瓣反流手术矫正后（调整后风险比，1.45[95%CI，1.02 - 2.05]；=0.039）均观察到这种额外的死亡率。诊断后3个月内接受手术的RVD患者8年生存率更高（73%±4%对43%±4%；<0.001），即使在调整后（调整后风险比，0.44[95%CI，0.29 - 0.67]；<0.001），尽管术后1个月死亡率有所增加（无RVD患者为0.5%，有RVD患者为7.1%；<0.001）。
在14.6%的重度DMR患者中观察到RVD，其与额外死亡率存在强烈且独立的关联，二尖瓣手术可部分减轻这种关联。因此，右心室收缩功能评估应纳入常规DMR评估及临床决策过程中。
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