Assessing proportionate and disproportionate functional mitral regurgitation with individualized thresholds
The concept of proportionate/disproportionate functional mitral regurgitation (FMR) has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority. The aim of this study was to evaluate the prognostic value of an individualized method of asses...
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| Veröffentlicht in: | European heart journal cardiovascular imaging 2022-02, Vol.23 (3), p.431-440 |
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| creator | Lopes, Pedro M Albuquerque, Francisco Freitas, Pedro Gama, Francisco Horta, Eduarda Reis, Carla Abecasis, João Trabulo, Marisa Ferreira, António M Aguiar, Carlos Canada, Manuel Ribeiras, Regina Mendes, Miguel Andrade, Maria J |
| description | The concept of proportionate/disproportionate functional mitral regurgitation (FMR) has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority. The aim of this study was to evaluate the prognostic value of an individualized method of assessing FMR proportionality.
We retrospectively identified 572 patients with at least mild FMR and reduced left ventricular ejection fraction ( |
| doi_str_mv | 10.1093/ehjci/jeab023 |
| format | Article |
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We retrospectively identified 572 patients with at least mild FMR and reduced left ventricular ejection fraction (<50%) under medical therapy. To determine FMR proportionality status, we used an approach where a simple equation determined the individualized theoretical regurgitant volume (or effective regurgitant orifice area) threshold associated with haemodynamically significant FMR. Then, we compared the measured with the theoretical value to categorize the population into non-severe, proportionate, and disproportionate FMR. The primary endpoint was all-cause mortality. During a median follow-up of 3.8 years (interquartile range: 1.8-6.2), 254 patients died. The unadjusted mortality incidence per 100 persons-year rose as the degree of FMR disproportionality worsened. On multivariable analysis, disproportionate FMR remained independently associated with all-cause mortality [adjusted hazard ratio: 1.785; 95% confidence interval (CI): 1.249-2.550; P = 0.001]. The FMR proportionality concept showed greater discriminative power (C-statistic 0.639; 95% CI: 0.597-0.680) than the American (C-statistic 0.583; 95% CI: 0.546-0.621; P for comparison <0.001) and European guidelines (C-statistic 0.584; 95% CI: 0.547-0.620; P for comparison <0.001). When added to any of the before-mentioned guidelines, FMR proportionality also improved risk stratification by reclassifying patients into lower and higher risk subsets.
Disproportionate FMR is independently associated with all-cause mortality and improves the risk stratification of current guidelines.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jeab023</identifier><identifier>PMID: 33637993</identifier><language>eng</language><publisher>England</publisher><subject>Humans ; Mitral Valve Insufficiency - etiology ; Prognosis ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left</subject><ispartof>European heart journal cardiovascular imaging, 2022-02, Vol.23 (3), p.431-440</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c293t-89d133b6e3edc45d8e25b853780084a2fd938cac7853559f3fe3e4af35b1719b3</citedby><cites>FETCH-LOGICAL-c293t-89d133b6e3edc45d8e25b853780084a2fd938cac7853559f3fe3e4af35b1719b3</cites><orcidid>0000-0001-9968-477X ; 0000-0002-1623-7382 ; 0000-0002-1536-7855 ; 0000-0002-4741-8178</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33637993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopes, Pedro M</creatorcontrib><creatorcontrib>Albuquerque, Francisco</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Gama, Francisco</creatorcontrib><creatorcontrib>Horta, Eduarda</creatorcontrib><creatorcontrib>Reis, Carla</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Trabulo, Marisa</creatorcontrib><creatorcontrib>Ferreira, António M</creatorcontrib><creatorcontrib>Aguiar, Carlos</creatorcontrib><creatorcontrib>Canada, Manuel</creatorcontrib><creatorcontrib>Ribeiras, Regina</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><creatorcontrib>Andrade, Maria J</creatorcontrib><title>Assessing proportionate and disproportionate functional mitral regurgitation with individualized thresholds</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>The concept of proportionate/disproportionate functional mitral regurgitation (FMR) has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority. The aim of this study was to evaluate the prognostic value of an individualized method of assessing FMR proportionality.
We retrospectively identified 572 patients with at least mild FMR and reduced left ventricular ejection fraction (<50%) under medical therapy. To determine FMR proportionality status, we used an approach where a simple equation determined the individualized theoretical regurgitant volume (or effective regurgitant orifice area) threshold associated with haemodynamically significant FMR. Then, we compared the measured with the theoretical value to categorize the population into non-severe, proportionate, and disproportionate FMR. The primary endpoint was all-cause mortality. During a median follow-up of 3.8 years (interquartile range: 1.8-6.2), 254 patients died. The unadjusted mortality incidence per 100 persons-year rose as the degree of FMR disproportionality worsened. On multivariable analysis, disproportionate FMR remained independently associated with all-cause mortality [adjusted hazard ratio: 1.785; 95% confidence interval (CI): 1.249-2.550; P = 0.001]. The FMR proportionality concept showed greater discriminative power (C-statistic 0.639; 95% CI: 0.597-0.680) than the American (C-statistic 0.583; 95% CI: 0.546-0.621; P for comparison <0.001) and European guidelines (C-statistic 0.584; 95% CI: 0.547-0.620; P for comparison <0.001). When added to any of the before-mentioned guidelines, FMR proportionality also improved risk stratification by reclassifying patients into lower and higher risk subsets.
Disproportionate FMR is independently associated with all-cause mortality and improves the risk stratification of current guidelines.</description><subject>Humans</subject><subject>Mitral Valve Insufficiency - etiology</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkEtPwzAQhC0EolXpkSvKkUuo7XWa-FhVvKRKXOAcOfamccmj2A4Ifj3pg0rsZUajT6PVEHLN6B2jEmZYbbSdbVAVlMMZGXMq0pgLxs9PnooRmXq_ocMlYi44uyQjgDmkUsKYvC-8R-9tu462rtt2LtiuVQEj1ZrIWP8_LPtW730dNTa4QRyue7e2Qe3i6MuGKrKtsZ_W9Kq2P2iiUDn0VVcbf0UuSlV7nB51Qt4e7l-XT_Hq5fF5uVjFmksIcSYNAyjmCGi0SEyGPCmyBNKM0kwoXhoJmVY6HbIkkSWUAylUCUnBUiYLmJDbQ-_w_EePPuSN9RrrWrXY9T7nQgqgIEAOaHxAteu8d1jmW2cb5b5zRvPdxPl-4vw48cDfHKv7okFzov8GhV-lf3x0</recordid><startdate>20220222</startdate><enddate>20220222</enddate><creator>Lopes, Pedro M</creator><creator>Albuquerque, Francisco</creator><creator>Freitas, Pedro</creator><creator>Gama, Francisco</creator><creator>Horta, Eduarda</creator><creator>Reis, Carla</creator><creator>Abecasis, João</creator><creator>Trabulo, Marisa</creator><creator>Ferreira, António M</creator><creator>Aguiar, Carlos</creator><creator>Canada, Manuel</creator><creator>Ribeiras, Regina</creator><creator>Mendes, Miguel</creator><creator>Andrade, Maria J</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9968-477X</orcidid><orcidid>https://orcid.org/0000-0002-1623-7382</orcidid><orcidid>https://orcid.org/0000-0002-1536-7855</orcidid><orcidid>https://orcid.org/0000-0002-4741-8178</orcidid></search><sort><creationdate>20220222</creationdate><title>Assessing proportionate and disproportionate functional mitral regurgitation with individualized thresholds</title><author>Lopes, Pedro M ; Albuquerque, Francisco ; Freitas, Pedro ; Gama, Francisco ; Horta, Eduarda ; Reis, Carla ; Abecasis, João ; Trabulo, Marisa ; Ferreira, António M ; Aguiar, Carlos ; Canada, Manuel ; Ribeiras, Regina ; Mendes, Miguel ; Andrade, Maria J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c293t-89d133b6e3edc45d8e25b853780084a2fd938cac7853559f3fe3e4af35b1719b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Humans</topic><topic>Mitral Valve Insufficiency - etiology</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopes, Pedro M</creatorcontrib><creatorcontrib>Albuquerque, Francisco</creatorcontrib><creatorcontrib>Freitas, Pedro</creatorcontrib><creatorcontrib>Gama, Francisco</creatorcontrib><creatorcontrib>Horta, Eduarda</creatorcontrib><creatorcontrib>Reis, Carla</creatorcontrib><creatorcontrib>Abecasis, João</creatorcontrib><creatorcontrib>Trabulo, Marisa</creatorcontrib><creatorcontrib>Ferreira, António M</creatorcontrib><creatorcontrib>Aguiar, Carlos</creatorcontrib><creatorcontrib>Canada, Manuel</creatorcontrib><creatorcontrib>Ribeiras, Regina</creatorcontrib><creatorcontrib>Mendes, Miguel</creatorcontrib><creatorcontrib>Andrade, Maria J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopes, Pedro M</au><au>Albuquerque, Francisco</au><au>Freitas, Pedro</au><au>Gama, Francisco</au><au>Horta, Eduarda</au><au>Reis, Carla</au><au>Abecasis, João</au><au>Trabulo, Marisa</au><au>Ferreira, António M</au><au>Aguiar, Carlos</au><au>Canada, Manuel</au><au>Ribeiras, Regina</au><au>Mendes, Miguel</au><au>Andrade, Maria J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing proportionate and disproportionate functional mitral regurgitation with individualized thresholds</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2022-02-22</date><risdate>2022</risdate><volume>23</volume><issue>3</issue><spage>431</spage><epage>440</epage><pages>431-440</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract>The concept of proportionate/disproportionate functional mitral regurgitation (FMR) has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority. The aim of this study was to evaluate the prognostic value of an individualized method of assessing FMR proportionality.
We retrospectively identified 572 patients with at least mild FMR and reduced left ventricular ejection fraction (<50%) under medical therapy. To determine FMR proportionality status, we used an approach where a simple equation determined the individualized theoretical regurgitant volume (or effective regurgitant orifice area) threshold associated with haemodynamically significant FMR. Then, we compared the measured with the theoretical value to categorize the population into non-severe, proportionate, and disproportionate FMR. The primary endpoint was all-cause mortality. During a median follow-up of 3.8 years (interquartile range: 1.8-6.2), 254 patients died. The unadjusted mortality incidence per 100 persons-year rose as the degree of FMR disproportionality worsened. On multivariable analysis, disproportionate FMR remained independently associated with all-cause mortality [adjusted hazard ratio: 1.785; 95% confidence interval (CI): 1.249-2.550; P = 0.001]. The FMR proportionality concept showed greater discriminative power (C-statistic 0.639; 95% CI: 0.597-0.680) than the American (C-statistic 0.583; 95% CI: 0.546-0.621; P for comparison <0.001) and European guidelines (C-statistic 0.584; 95% CI: 0.547-0.620; P for comparison <0.001). When added to any of the before-mentioned guidelines, FMR proportionality also improved risk stratification by reclassifying patients into lower and higher risk subsets.
Disproportionate FMR is independently associated with all-cause mortality and improves the risk stratification of current guidelines.</abstract><cop>England</cop><pmid>33637993</pmid><doi>10.1093/ehjci/jeab023</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9968-477X</orcidid><orcidid>https://orcid.org/0000-0002-1623-7382</orcidid><orcidid>https://orcid.org/0000-0002-1536-7855</orcidid><orcidid>https://orcid.org/0000-0002-4741-8178</orcidid></addata></record> |
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| ispartof | European heart journal cardiovascular imaging, 2022-02, Vol.23 (3), p.431-440 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Humans Mitral Valve Insufficiency - etiology Prognosis Retrospective Studies Stroke Volume Ventricular Function, Left |
| title | Assessing proportionate and disproportionate functional mitral regurgitation with individualized thresholds |
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