Page 73 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

ACE inhibitor/ ARB
MRA
ICD therapy
Total Population (N = 379)
297 (78)
184 (49) 57 (15)
RVol/EDV Ratio <20% (n = 244)
193 (79)
124 (51) 42 (17)
RVol/EDV
Ratio ≥20% (n = 135)
104 (77)
60 (44) 15 (11)
p Value
0.641
0.234 0.112
Continuous data are mean ± SD. Categorical data are n (%).
ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; BSA = body surface area; EDV = end-diastolic volume; eGFR = estimated glomerular filtration rate; ICD = implantable cardioverter- defibrillator; MRA = mineralocorticoid receptor antagonist; NYHA = New York Heart Association; RVol = regurgitant volume.
Table 2. Echocardiographic Characteristics at Baseline According to RVol/EDV Ratio
LVEDV (ml)
LVESV (ml) LVEF (%)
VC width (mm)
PISA
EROA (mm∗ 2) RVol (ml) LAVI (ml/m2)
RVol/EDV ratio RF (%)
RVol (ml)†
Total Population (N = 379)
189 (138–245) 136 (92–184)
30 ± 11 6.0 ± 0.18
24 ± 11
34 ± 15
33 (25–44) 21 ± 14
77 (71–83) 174 ± 79
RVol/EDV
Ratio <20% (n = 244) 222 (181–276)
165 (131–210)
26 ± 8
6.0 ± 0.18
22 ± 11
29 ± 10
33 (25–41) 13 ± 4
76 (71–83) 171 ± 74
RVol/EDV
Ratio ≥20% (n = 135) 123 (95–170)
77 (53–107)
38 ± 12
6.1 ± 0.18
27 ± 12
44 ± 18
34 (25–48) 35 ± 14
78 (72–84) 181 ± 90
p Value
<0.001‡ <0.001 <0.001 0.557
<0.001 <0.001‡ 0.324 <0.001 0.226 0.259
Continuous data are mean ± SD or median (interquartile range). Categorical data are n (%).
EROA = effective regurgitant orifice area; LAVI = left atrial volume index; LVEF = left ventricular ejection fraction; LVEDV = left ventricular end-diastolic volume; LVESV = left ventricular end-systolic volume; PISA = proximal isovelocity surface area; RF = regurgitant fraction; VC = vena contracta; other abbreviations as in Table 1.
∗ RVol measured according to the PISA method; † RVol derived from RF; ‡ The p value for LVEDV and RVol demonstrating significance is indicated for illustrative purpose, due to confounding.
A total of 244 (64.4%) patients had RVol/EDV ratio <20%; the remaining 135 (35.6%) patients had RVol/EDV ratio ≥20%. Patients with a high RVol/EDV ratio (≥20%) were more frequently male and had a higher prevalence of atrial fibrillation and hypertension compared with those with a low RVol/EDV ratio (<20%). Those with a high RVol/EDV ratio (≥20%) had less severe HF symptoms and were less frequently using diuretic agents than their counterparts. In terms of echocardiographic characteristics, patients with a high RVol/EDV ratio (≥20%) had smaller LV volumes with higher LVEFs compared with those with a low RVol/EDV ratio (<20%). In addition, patients with a high RVol/ EDV ratio (≥20%) had larger EROA and RVol compared with those with a low RVol/EDV
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