Pai RG, Varadarajan P. Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement. World J Cardiol 2023; 15(5): 253-261 [PMID: 37274375 DOI: 10.4330/wjc.v15.i5.253]
Corresponding Author of This Article
Ramdas G Pai, FACC, FRCP (Hon), MD, Doctor, Professor, Department of Cardiology, University of California Riverside School of Medicine, Riverside/St. Bernardine Medical Center, San Bernardino, Riverside, CA 92507, United States. ramdaspai@yahoo.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. May 26, 2023; 15(5): 253-261 Published online May 26, 2023. doi: 10.4330/wjc.v15.i5.253
Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement
Ramdas G Pai, Padmini Varadarajan
Ramdas G Pai, Department of Cardiology, University of California Riverside School of Medicine, Riverside/St. Bernardine Medical Center, San Bernardino, Riverside, CA 92521, United States
Padmini Varadarajan, Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92521, United States
Author contributions: Pai RG and Varadarajan P designed the study, analyzed the data, wrote the manuscript and revised the final form.
Institutional review board statement: The research project was approved by the institutional review board of Loma Linda University, Loma Linda, California.
Informed consent statement: A need for an informed consent was waived because of its retrospective, observational study design without any intervention.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramdas G Pai, FACC, FRCP (Hon), MD, Doctor, Professor, Department of Cardiology, University of California Riverside School of Medicine, Riverside/St. Bernardine Medical Center, San Bernardino, Riverside, CA 92507, United States. ramdaspai@yahoo.com
Received: December 20, 2022 Peer-review started: December 20, 2022 First decision: February 20, 2023 Revised: March 20, 2023 Accepted: April 25, 2023 Article in press: April 25, 2023 Published online: May 26, 2023
ARTICLE HIGHLIGHTS
Research background
Severe aortic stenosis (AR) and concomitant mitral regurgitation (MR) are common. But the impact of MR in those with severe AS on outcomes and management are unknown.
Research motivation
To study the impact of concomitant MR on outcomes in severe AS.
Research objectives
Does MR affect prognosis and decision making in severe AS patients.
Research methods
Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003, 287 underwent AVR forming the study cohort. They were followed up to death or till the end of 2019. Chart reviews were performed for clinical, echocardiographic, and therapeutic data. MR was graded on a 1-4 scale. Mortality data was obtained from chart review and the Social Security Death Index. Survival was analyzed as a function of degree of MR.
Research results
Presence of MR was associated with higher mortality in a graded fashion. MR was significantly associated with lower left ventricular (LV) ejection fraction and larger LV size. Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size. By Cox regression, MR, lower ejection fraction (EF) and larger LV end-systolic dimension were independent predictors of higher mortality.
Research conclusions
Presence of greater than 2+ MR in patients with severe AS is independently associated with reduced survival in surgically managed patients, an effect incremental to reduced EF and larger LV size. We suggest that aortic valve intervention should be considered in severe AS patients when > 2+ MR occurs irrespective of EF or symptoms.
Research perspectives
More studies are needed to study the mechanisms of MR and its prevention in severe AS patients.
