The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation
<i>Background</i>: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. <i>Objective</i>: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with signifi...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/2/49 |
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| author | Alon Shechter Steele C. Butcher Robert J. Siegel Jenan Awesat Merry Abitbol Mordehay Vaturi Alex Sagie Ran Kornowski Yaron Shapira Idit Yedidya |
| author_facet | Alon Shechter Steele C. Butcher Robert J. Siegel Jenan Awesat Merry Abitbol Mordehay Vaturi Alex Sagie Ran Kornowski Yaron Shapira Idit Yedidya |
| author_sort | Alon Shechter |
| collection | DOAJ |
| description | <i>Background</i>: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. <i>Objective</i>: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. <i>Methods</i>: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. <i>Results</i>: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all <i>p</i> < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, <i>p</i> = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, <i>p</i> = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, <i>p</i> = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR. |
| first_indexed | 2024-03-11T08:39:03Z |
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| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T08:39:03Z |
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| spelling | doaj.art-cb16a708fd6b46d6978b6ed513bbc2652023-11-16T21:16:19ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-01-011024910.3390/jcdd10020049The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral RegurgitationAlon Shechter0Steele C. Butcher1Robert J. Siegel2Jenan Awesat3Merry Abitbol4Mordehay Vaturi5Alex Sagie6Ran Kornowski7Yaron Shapira8Idit Yedidya9Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Royal Perth Hospital, Perth, WA 6000, AustraliaDepartment of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USADepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, IsraelDepartment of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel<i>Background</i>: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. <i>Objective</i>: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. <i>Methods</i>: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. <i>Results</i>: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all <i>p</i> < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, <i>p</i> = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, <i>p</i> = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, <i>p</i> = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR.https://www.mdpi.com/2308-3425/10/2/49degenerative mitral regurgitationpulmonary veinsatrial fibrillationprognosis |
| spellingShingle | Alon Shechter Steele C. Butcher Robert J. Siegel Jenan Awesat Merry Abitbol Mordehay Vaturi Alex Sagie Ran Kornowski Yaron Shapira Idit Yedidya The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation Journal of Cardiovascular Development and Disease degenerative mitral regurgitation pulmonary veins atrial fibrillation prognosis |
| title | The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation |
| title_full | The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation |
| title_fullStr | The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation |
| title_full_unstemmed | The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation |
| title_short | The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation |
| title_sort | prognostic value of pulmonary venous flow reversal in patients with significant degenerative mitral regurgitation |
| topic | degenerative mitral regurgitation pulmonary veins atrial fibrillation prognosis |
| url | https://www.mdpi.com/2308-3425/10/2/49 |
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