Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention
BackgroundIschemic mitral regurgitation is associated with substantial risk of death. Although surgical mitral valve intervention (MVi) may improve symptoms, it has not been shown to improve survival. The aim of this study was to identify predictors of mortality in patients with ischemic mitral regu...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007163 |
| _version_ | 1811332281340526592 |
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| author | Kenya Kusunose Nancy A. Obuchowski Marc Gillinov Zoran B. Popovic Scott D. Flamm Brian P. Griffin Deborah H. Kwon |
| author_facet | Kenya Kusunose Nancy A. Obuchowski Marc Gillinov Zoran B. Popovic Scott D. Flamm Brian P. Griffin Deborah H. Kwon |
| author_sort | Kenya Kusunose |
| collection | DOAJ |
| description | BackgroundIschemic mitral regurgitation is associated with substantial risk of death. Although surgical mitral valve intervention (MVi) may improve symptoms, it has not been shown to improve survival. The aim of this study was to identify predictors of mortality in patients with ischemic mitral regurgitation and MVi. Methods and ResultsWe evaluated 117 consecutive patients (age, 65±10 years) with advanced ischemic cardiomyopathy who underwent cardiac magnetic resonance and subsequent MVi between January 1, 2002 and January 1, 2012. Cardiac magnetic resonance was used to assess left ventricular remodeling and myocardial scarring. The effective regurgitant orifice area was calculated from the proximal isovelocity surface area by echocardiography. There were 43 deaths (37%) during follow‐up (median, 62 months). On multivariable analysis, age ≥70 years (P=0.013), diabetes mellitus (P=0.001), dyslipidemia (P=0.012), papillary muscle scar (P=0.010), incomplete revascularization (P=0.001), and total scar %×effective regurgitant orifice area ≥0.20 cm2 (P=0.005) were each independently associated with all‐cause mortality. Although patients with effective regurgitant orifice area <0.2 cm2 at baseline demonstrated an increased hazard ratio of 3.3 for every 10% increase in scar, the hazard ratio increased to 9 for every 10% increase in scar in those with baseline effective regurgitant orifice area ≥0.20 cm2. Mortality also was significantly higher in patients with incomplete revascularization compared with those with vascularized viable myocardium (61% versus 28%; P<0.001). ConclusionsIncreased total scar burden and the presence of incomplete revascularization are powerful predictors of mortality in patients with advanced ischemic cardiomyopathy undergoing MVi. Viability assessment with cardiac magnetic resonance imaging can identify which patients with ischemic mitral regurgitation are at highest risk for mortality after surgical MVi. |
| first_indexed | 2024-04-13T16:34:20Z |
| format | Article |
| id | doaj.art-9b3316788c2748889d1ffdb84f48af15 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:34:20Z |
| publishDate | 2017-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-9b3316788c2748889d1ffdb84f48af152022-12-22T02:39:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-11-0161110.1161/JAHA.117.007163Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve InterventionKenya Kusunose0Nancy A. Obuchowski1Marc Gillinov2Zoran B. Popovic3Scott D. Flamm4Brian P. Griffin5Deborah H. Kwon6Heart and Vascular Institute, Cleveland Clinic, Cleveland, OHImaging Institute, Cleveland Clinic, Cleveland, OHHeart and Vascular Institute, Cleveland Clinic, Cleveland, OHHeart and Vascular Institute, Cleveland Clinic, Cleveland, OHHeart and Vascular Institute, Cleveland Clinic, Cleveland, OHHeart and Vascular Institute, Cleveland Clinic, Cleveland, OHHeart and Vascular Institute, Cleveland Clinic, Cleveland, OHBackgroundIschemic mitral regurgitation is associated with substantial risk of death. Although surgical mitral valve intervention (MVi) may improve symptoms, it has not been shown to improve survival. The aim of this study was to identify predictors of mortality in patients with ischemic mitral regurgitation and MVi. Methods and ResultsWe evaluated 117 consecutive patients (age, 65±10 years) with advanced ischemic cardiomyopathy who underwent cardiac magnetic resonance and subsequent MVi between January 1, 2002 and January 1, 2012. Cardiac magnetic resonance was used to assess left ventricular remodeling and myocardial scarring. The effective regurgitant orifice area was calculated from the proximal isovelocity surface area by echocardiography. There were 43 deaths (37%) during follow‐up (median, 62 months). On multivariable analysis, age ≥70 years (P=0.013), diabetes mellitus (P=0.001), dyslipidemia (P=0.012), papillary muscle scar (P=0.010), incomplete revascularization (P=0.001), and total scar %×effective regurgitant orifice area ≥0.20 cm2 (P=0.005) were each independently associated with all‐cause mortality. Although patients with effective regurgitant orifice area <0.2 cm2 at baseline demonstrated an increased hazard ratio of 3.3 for every 10% increase in scar, the hazard ratio increased to 9 for every 10% increase in scar in those with baseline effective regurgitant orifice area ≥0.20 cm2. Mortality also was significantly higher in patients with incomplete revascularization compared with those with vascularized viable myocardium (61% versus 28%; P<0.001). ConclusionsIncreased total scar burden and the presence of incomplete revascularization are powerful predictors of mortality in patients with advanced ischemic cardiomyopathy undergoing MVi. Viability assessment with cardiac magnetic resonance imaging can identify which patients with ischemic mitral regurgitation are at highest risk for mortality after surgical MVi.https://www.ahajournals.org/doi/10.1161/JAHA.117.007163ischemic cardiomyopathymagnetic resonance imagingmitral valve regurgitationmyocardial delayed enhancementrevascularization |
| spellingShingle | Kenya Kusunose Nancy A. Obuchowski Marc Gillinov Zoran B. Popovic Scott D. Flamm Brian P. Griffin Deborah H. Kwon Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemic cardiomyopathy magnetic resonance imaging mitral valve regurgitation myocardial delayed enhancement revascularization |
| title | Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention |
| title_full | Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention |
| title_fullStr | Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention |
| title_full_unstemmed | Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention |
| title_short | Predictors of Mortality in Patients With Severe Ischemic Cardiomyopathy Undergoing Surgical Mitral Valve Intervention |
| title_sort | predictors of mortality in patients with severe ischemic cardiomyopathy undergoing surgical mitral valve intervention |
| topic | ischemic cardiomyopathy magnetic resonance imaging mitral valve regurgitation myocardial delayed enhancement revascularization |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007163 |
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