Page 76 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter four. Regurgitant Volume/Left Ventricular End-Diastolic Volume Ratio
interventions. (B) All follow-up data, including after mitral valve interventions. Dashed lines represent 95% confidence intervals. EDV = end-diastolic volume; RVol = regurgitant volume.
Table 4. Univariable and Multivariable Predictors of All-Cause Mortality in All Patients
(Including Those Undergoing Mitral Valve Interventions)
Age (yrs) 1.02 Male 1.32 BSA (m2) 1.01 eGFR (ml/min/1.73 m2) 0.98 Hypertension 1.09 Diabetes mellitus 1.33 Atrial fibrillation 0.96 Ischemic etiology 1.16 NYHA functional 1.12 classification ≥II
Beta-blockers ∗ 0.83 MV interventions 0.87 MV interventions† 0.99 LAVI (ml/m2) 1.01 RVol/EDV ratio (per 5% 0.93 increment)
1.01–1.04 0.98–1.77 0.54–1.90 0.97–0.99 0.82–1.44 0.97–1.82 0.72–1.27 0.88–1.54 0.64–1.97
0.62–1.11
0.65–1.15 0.99–1.00 0.99–1.01 0.87–0.99
Unadjusted
HR 95% CI
p Value
0.001 0.069 0.975 <0.001 0.556 0.080 0.755 0.287 0.691
0.200
0.310 0.084 0.119 0.015
Adjusted
HR 95% CI 1.01 1.00–1.03 — —
0.98 0.97–0.99 — —
— —
— —
0.93 0.87–0.99
p Value
0.077 —
<0.001 —
—
—
0.023
BSA = body surface area; CI = confidence interval; EDV = end-diastolic volume; eGFR = estimated glomerular filtration rate; HR = hazard ratio; LAVI = left atrial volume index; MV = mitral valve; NYHA = New York Heart Association; RVol = regurgitant volume.
∗ Surgical mitral valve repair, mitral valve replacement, and percutaneous edge-to-edge mitral valve repair compared with optimal medical therapy alone.
† Mitral valve interventions introduced as a time-dependent covariate.
Discussion
In the present study, a high RVol/EDV ratio was associated with a trend toward increased all-cause mortality during medical therapy in patients with moderate and severe secondary MR. Conversely, allowing for the effects of MV interventions, a high RVol/EDV ratio was independently associated with lower all-cause mortality during follow-up.
In contrast to other Doppler echocardiographic measures of secondary MR, the RVol/ EDV ratio takes into consideration the degree of LV remodeling as well as MR severity. Thus, this ratio may help identify patients who are likely to benefit from transcatheter and surgical therapies that aim to reduce MR. For the same value of RVol, a patient
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