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Regurgitant Volume/Left Ventricular End-Diastolic Volume Ratio

Abstract : Objectives : The purpose of this study was to investigate the prognostic implications of the ratio of mitral regurgitant volume (RVol) to left ventricular (LV) end-diastolic volume (EDV) in patients with significant secondary mitral regurgitation (MR). Background : Quantification of secondary MR remains challenging, and its severity can be over- or underestimated when using the proximal isovelocity surface area method, which does not take LV volume into account. This limitation can be addressed by normalizing mitral RVol to LVEDV. Methods : A total of 379 patients (mean age 67 ± 11 years; 63% male) with significant (moderate and severe) secondary MR were divided into 2 groups according to the RVol/EDV ratio: RVol/EDV ≥20% (greater MR/smaller EDV) and <20% (smaller MR/larger EDV). The primary endpoint was all-cause mortality. Results : During median (interquartile range) follow-up of 50 (26 to 94) months, 199 (52.5%) patients died. When considering patients receiving medical therapy only, patients with RVol/EDV ratio ≥20% tended to have higher mortality rates than those with RVol/EDV ratio <20% (5-year estimated rates 24.1% vs. 18.4%, respectively; p = 0.077). Conversely, when considering the entire follow-up period including mitral valve interventions, patients with a higher RVol/EDV ratio (≥20%) had lower rates of all-cause mortality compared with patients with RVol/EDV ratio <20% (5-year estimated rates 39.0% vs. 44.8%, respectively; p = 0.018). On multivariable analysis, higher RVol/EDV ratio (per 5% increment as a continuous variable) was independently associated with lower all-cause mortality (0.93; p = 0.023). Conclusions : In patients with significant secondary MR treated medically, survival tended to be lower in those with a higher RVol/EDV ratio. Conversely, a higher RVol/EDV ratio was independently associated with reduced all-cause mortality. when mitral valve interventions were taken into consideration.
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https://hal-univ-paris.archives-ouvertes.fr/hal-03250601
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Submitted on : Friday, June 4, 2021 - 5:57:27 PM
Last modification on : Sunday, June 6, 2021 - 3:21:23 AM

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Farnaz Namazi, Pieter van der Bijl, Federico Fortuni, Bart J.A. Mertens, Vasileios Kamperidis, et al.. Regurgitant Volume/Left Ventricular End-Diastolic Volume Ratio. JACC: Cardiovascular Imaging, Elsevier/American College of Cardiology, 2021, 14 (4), pp.730-739. ⟨10.1016/j.jcmg.2020.06.032⟩. ⟨hal-03250601⟩

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