CLINICAL RESEARCH: LEFT VENTRICULAR DYSFUNCTION
Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction
Audrey H. Wu, MD, MPH*,
Keith D. Aaronson, MD, MS*,
Steven F. Bolling, MD, FACC ,
Francis D. Pagani, MD, PhD, FACC,
Kathy Welch, MS, MPH and
Todd M. Koelling, MD, FACC*,*
* Division of Cardiology, Department of Internal Medicine
Section of Cardiac Surgery, Department of Surgery
Center for Statistical Consultation and Research, University of Michigan Health Systems, Ann Arbor, Michigan.
Manuscript received February 10, 2004;
revised manuscript received September 17, 2004,
accepted September 21, 2004.
* Reprint requests and correspondence: Dr. Todd M. Koelling, University of Michigan Health Systems, Women's Hospital, Room L3623, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0271 (Email: tkoellin{at}med.umich.edu).
OBJECTIVES: This study was designed to assess effects of mitral valve annuloplasty (MVA) on mortality in patients with mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction.
BACKGROUND: Mitral valve annuloplasty improves hemodynamics and symptoms in these patients, but effects on long-term mortality are not well established.
METHODS: We retrospectively analyzed consecutive patients with significant MR and LV systolic dysfunction on echocardiography between 1995 and 2002. Cox regression analysis, including MVA as a time-dependent covariate and propensity scoring to adjust for differing probabilities of undergoing MVA, was used to identify predictors of death, LV assist device implantation, or United Network for Organ Sharing-1 heart transplantation.
RESULTS: Of 682 patients identified, 419 were deemed surgical candidates; 126 underwent MVA. Propensity score derivation identified age, ejection fraction, and LV dimension to be associated with undergoing MVA. End points were reached in 120 (41%) non-MVA and 62 (49%) MVA patients. Increased risk of end point was associated with coronary artery disease (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.30 to 2.49), blood urea nitrogen (HR 1.01, 95% CI 1.005 to 1.02), cancer (HR 2.77, 95% CI 1.45 to 5.30), and digoxin (HR 1.66, 95% CI 1.15 to 2.39). Reduced risk was associated with angiotensin-converting enzyme inhibitors (HR 0.65, 95% CI 0.44 to 0.95), beta-blockers (HR 0.59, 95% CI 0.42 to 0.83), mean arterial pressure (HR 0.98, 95% CI 0.97 to 0.99), and serum sodium (HR 0.93, 95% CI 0.90 to 0.96). Mitral valve annuloplasty did not predict clinical outcome.
CONCLUSIONS: In this analysis, there is no clearly demonstrable mortality benefit conferred by MVA for significant MR with severe LV dysfunction. A prospective randomized control trial is warranted for further study of mortality with MVA in this population.
|
Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | CI = confidence interval | | HF = heart failure | | HR = hazard ratio | | LV = left ventricular | | MR = mitral regurgitation | | MVA = mitral valve annuloplasty | | OR = odds ratio | | UNOS = United Network for Organ Sharing |
|
This article has been cited by other articles:
|
|
|
|
 
M. A. Acker
Should Moderate or Greater Mitral Regurgitation Be Repaired in All Patients With LVEF <30%?
Circ Heart Fail,
November 1, 2008;
1(4):
281 - 284.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. McGee Jr
Should Moderate or Greater Mitral Regurgitation Be Repaired in All Patients With LVEF <30%?
Circ Heart Fail,
November 1, 2008;
1(4):
285 - 289.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
October 7, 2008;
118(15):
e523 - e661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
e1 - e142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Cleland, N. Freemantle, S. Ghio, F. Fruhwald, A. Shankar, M. Marijanowski, Y. Verboven, and L. Tavazzi
Predicting the Long-Term Effects of Cardiac Resynchronization Therapy on Mortality From Baseline Variables and the Early Response: A Report From the CARE-HF (Cardiac Resynchronization in Heart Failure) Trial
J. Am. Coll. Cardiol.,
August 5, 2008;
52(6):
438 - 445.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Calafiore, V. Mazzei, A. L. Iaco, M. Contini, A. Bivona, M. Gagliardi, P. Bosco, S. Gallina, and M. Di Mauro
Impact of ischemic mitral regurgitation on long-term outcome of patients with ejection fraction above 0.30 undergoing first isolated myocardial revascularization.
Ann. Thorac. Surg.,
August 1, 2008;
86(2):
458 - 464.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Carabello
The Current Therapy for Mitral Regurgitation
J. Am. Coll. Cardiol.,
July 29, 2008;
52(5):
319 - 326.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. Timek, D. Liang, G. T. Daughters, N. B. Ingels Jr., and D. C. Miller
Effect of local annular interventions on annular and left ventricular geometry
Eur. J. Cardiothorac. Surg.,
June 1, 2008;
33(6):
1049 - 1054.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. D. Crabtree, M. S. Bailey, M. R. Moon, N. Munfakh, M. K. Pasque, J. S. Lawton, N. Moazami, K. A. Aubuchon, A. S. Al-Dadah, and R. J. Damiano Jr
Recurrent mitral regurgitation and risk factors for early and late mortality after mitral valve repair for functional ischemic mitral regurgitation.
Ann. Thorac. Surg.,
May 1, 2008;
85(5):
1537 - 1542.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Agricola, M. Oppizzi, M. Pisani, A. Meris, F. Maisano, and A. Margonato
Ischemic mitral regurgitation: mechanisms and echocardiographic classification
Eur J Echocardiogr,
March 1, 2008;
9(2):
207 - 221.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Beeri, C. Yosefy, J. L. Guerrero, F. Nesta, S. Abedat, M. Chaput, F. del Monte, M. D. Handschumacher, R. Stroud, S. Sullivan, et al.
Mitral regurgitation augments post-myocardial infarction remodeling failure of hypertrophic compensation.
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
476 - 486.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, D. F. Loulmet, and D. Burkhoff
The conundrum of functional mitral regurgitation in chronic heart failure.
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
487 - 489.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena
Principles and Practice of Echocardiography in Cardiac Surgery
Card. Surg. Adult,
January 1, 2008;
3(2008):
315 - 348.
[Full Text]
|
|
|
|
|
|
|
W. Y. Szeto, R. C. Gorman, J. H. Gorman III, and M. A. Acker
Ischemic Mitral Regurgitation
Card. Surg. Adult,
January 1, 2008;
3(2008):
785 - 802.
[Full Text]
|
|
|
|
|
|
|
P. Lancellotti, E. Donal, B. Cosyns, G. Van Camp, J.-L. Monin, E. Brochet, A. Berrebi, P. Pibarot, C. Chauvel, C. Hassager, et al.
Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry)
Eur J Echocardiogr,
January 1, 2008;
9(1):
26 - 30.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Feldman and M. B. Leon
Prospects for Percutaneous Valve Therapies
Circulation,
December 11, 2007;
116(24):
2866 - 2877.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Suma, H. Tanabe, T. Uejima, S. Suzuki, T. Horii, and T. Isomura
Selected ventriculoplasty for idiopathic dilated cardiomyopathy with advanced congestive heart failure: midterm results and risk analysis
Eur. J. Cardiothorac. Surg.,
December 1, 2007;
32(6):
912 - 916.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Beeri, C. Yosefy, J. L. Guerrero, S. Abedat, M. D. Handschumacher, R. E. Stroud, S. Sullivan, M. Chaput, D. Gilon, G. J. Vlahakes, et al.
Early Repair of Moderate Ischemic Mitral Regurgitation Reverses Left Ventricular Remodeling: A Functional and Molecular Study
Circulation,
September 11, 2007;
116(11_suppl):
I-288 - I-293.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. B. Ratcliffe
Invited commentary
Ann. Thorac. Surg.,
July 1, 2007;
84(1):
101 - 102.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. H. Jones
Adding Mitral Valve Annuloplasty to Surgical Revascularization Does Not Benefit Patients With Functional Ischemic Mitral Regurgitation
J. Am. Coll. Cardiol.,
June 5, 2007;
49(22):
2202 - 2203.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Borger, P. M. Murphy, A. Alam, S. Fazel, M. Maganti, S. Armstrong, V. Rao, and T. E. David
Initial results of the chordal-cutting operation for ischemic mitral regurgitation
J. Thorac. Cardiovasc. Surg.,
June 1, 2007;
133(6):
1483 - 1492.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. B. D'Agostino Jr
Propensity Scores in Cardiovascular Research
Circulation,
May 1, 2007;
115(17):
2340 - 2343.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Magne, P. Pibarot, F. Dagenais, Z. Hachicha, J. G. Dumesnil, and M. Senechal
Preoperative Posterior Leaflet Angle Accurately Predicts Outcome After Restrictive Mitral Valve Annuloplasty for Ischemic Mitral Regurgitation
Circulation,
February 13, 2007;
115(6):
782 - 791.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pocar, A. Moneta, A. Grossi, and F. Donatelli
Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow-Up
Ann. Thorac. Surg.,
February 1, 2007;
83(2):
468 - 474.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al.
Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Eur. Heart J.,
January 26, 2007;
(2007)
ehl428v1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Suma, T. Isomura, T. Horii, and F. Nomura
Septal anterior ventricular exclusion procedure for idiopathic dilated cardiomyopathy.
Ann. Thorac. Surg.,
October 1, 2006;
82(4):
1344 - 1348.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Horii, H. Suma, T. Isomura, F. Nomura, and J. Hoshino
Left ventricle volume affects the result of mitral valve surgery for idiopathic dilated cardiomyopathy to treat congestive heart failure.
Ann. Thorac. Surg.,
October 1, 2006;
82(4):
1349 - 1355.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade, G. Sopko, L. De Luca, E. J. Velazquez, J. D. Parker, P. F. Binkley, Z. Sadowski, K. S. Golba, D. L. Prior, J. L. Rouleau, et al.
Navigating the Crossroads of Coronary Artery Disease and Heart Failure
Circulation,
September 12, 2006;
114(11):
1202 - 1213.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Grossi and G. A. Crooke
Mitral valve surgery in heart failure: Insights from the Acorn clinical trial.
J. Thorac. Cardiovasc. Surg.,
September 1, 2006;
132(3):
455 - 456.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Acker, S. Bolling, R. Shemin, J. Kirklin, J. K. Oh, D. L. Mann, M. Jessup, H. N. Sabbah, R. C. Starling, S. H. Kubo, et al.
Mitral valve surgery in heart failure: Insights from the Acorn Clinical Trial.
J. Thorac. Cardiovasc. Surg.,
September 1, 2006;
132(3):
568 - 577.e4.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
e1 - e148.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
598 - 675.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Spoor, A. Geltz, and S. F. Bolling
Flexible Versus Nonflexible Mitral Valve Rings for Congestive Heart Failure: Differential Durability of Repair
Circulation,
July 4, 2006;
114(1_suppl):
I-67 - I-71.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Cheng, T. C. Nguyen, M. Malinowski, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller
Effects of Undersized Mitral Annuloplasty on Regional Transmural Left Ventricular Wall Strains and Wall Thickening Mechanisms
Circulation,
July 4, 2006;
114(1_suppl):
I-600 - I-609.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Messas, A. Bel, M. C. Morichetti, C. Carrion, M. D. Handschumacher, S. Peyrard, J. T. Vilquin, M. Desnos, P. Bruneval, A. Carpentier, et al.
Autologous Myoblast Transplantation for Chronic Ischemic Mitral Regurgitation
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2086 - 2093.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2094 - 2107.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Mack
Percutaneous Mitral Valve Repair: A Fertile Field of Innovative Treatment Strategies
Circulation,
May 16, 2006;
113(19):
2269 - 2271.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, D. Sahn, and S. Tsimikas
Highlights of the Year in JACC 2005
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
184 - 202.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W.H. W. Tang and G. S. Francis
The Year in Heart Failure
J. Am. Coll. Cardiol.,
December 6, 2005;
46(11):
2125 - 2133.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Schwammenthal and R. A. Levine
The non-ischaemic dynamics of ischaemic mitral regurgitation: solving the paradox
Eur. Heart J.,
August 1, 2005;
26(15):
1454 - 1455.
[Full Text]
[PDF]
|
|
|
|
