Page 77 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation
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with low RVol/EDV ratio may not benefit as much as a patient with a high RVol/EDV ratio because the patient with a low RVol/EDV ratio has a much larger degree of LV remodeling that may not respond to MR reduction therapies. Similarly, for the same LVEDV, a patient with a high RVol/EDV ratio may benefit more from transcatheter or surgical therapies than a patient with a low RVol/EDV ratio because the volume overload caused by the MR is relatively greater in the former patient. This perspective is consistent with the concept of proportionate and disproportionate secondary MR as proposed by Packer and Grayburn (14).
Central Illustration. Association of RVol/EDV Ratio and Long-Term All-Cause Mortality in Patients With Secondary Mitral Regurgitation During Medical Treatment and After Surgical and Transcatheter Mitral Reduction Therapies
(A) All-cause mortality across a range of RVol/EDV ratios, plotted as a fitted spline model. The spline curve demonstrates a linearly increasing risk for mortality for lower RVol/EDV ratios. (B) Kaplan-Meier curves demonstrating the cumulative survival rate for all-cause mortality stratified according to a RVol/EDV ratio cutoff of 20%. EDV = end-diastolic volume; RVol = regurgitant volume.
In the present study, patients with a high RVol/EDV ratio (≥20%) tended to have worse survival during medical management than those with a low RVol/EDV ratio (<20%), suggesting that more severe MR with less LV dilation is associated with a worse prognosis. As expected, patients with a high RVol/EDV ratio (≥20%) more frequently underwent surgical correction of the MR, whereas patients with a low RVol/ EDV ratio (<20%) more frequently received cardiac resynchronization therapy. After MV interventions, the relative prognosis changed such that a baseline high RVol/EDV
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