Korean Circulation Journal

  • 제54권6호
  • /
  • Pages.311-322
  • /
  • 2024
  • /
  • 1738-5520(pISSN)
  • /
  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
권호 표지
DOI QR코드

DOI QR Code

Mitral Annular Tissue Velocity Predicts Survival in Patients With Primary Mitral Regurgitation

  • You-Jung Choi (Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Chan Soon Park (Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital) ;
  • Tae-Min Rhee (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Hyun-Jung Lee (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Hong-Mi Choi (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • In-Chang Hwang (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jun-Bean Park (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Yeonyee E. Yoon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jin Oh Na (Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Hyung-Kwan Kim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Yong-Jin Kim (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Goo-Yeong Cho (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Dae-Won Sohn (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Seung-Pyo Lee (Department of Internal Medicine, Seoul National University College of Medicine)
  • 투고 : 2023.11.03
  • 심사 : 2024.03.11
  • 발행 : 2024.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: Early diastolic mitral annular tissue (e') velocity is a commonly used marker of left ventricular (LV) diastolic function. This study aimed to investigate the prognostic implications of e' velocity in patients with mitral regurgitation (MR). Methods: This retrospective cohort study included 1,536 consecutive patients aged <65 years with moderate or severe chronic primary MR diagnosed between 2009 and 2018. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. According to the current guidelines, the cut-off value of e' velocity was defined as 7 cm/s. Results: A total of 404 individuals were enrolled (median age, 51.0 years; 64.1% male; 47.8% severe MR). During a median 6.0-year follow-up, there were 40 all-cause mortality and 16 cardiovascular deaths. Multivariate analysis revealed a significant association between e' velocity and all-cause death (adjusted hazard ratio [aHR], 0.770; 95% confidence interval [CI], 0.634-0.935; p=0.008) and cardiovascular death (aHR, 0.690; 95% CI, 0.477-0.998; p=0.049). Abnormal e' velocity (≤7 cm/s) independently predicted all-cause death (aHR, 2.467; 95% CI, 1.170-5.200; p=0.018) and cardiovascular death (aHR, 5.021; 95% CI, 1.189-21.211; p=0.028), regardless of symptoms, LV dimension and ejection fraction. Subgroup analysis according to sex, MR severity, mitral valve replacement/repair, and symptoms, showed no significant interactions. Including e' velocity in the 10-year risk score improved reclassification for mortality (net reclassification improvement [NRI], 0.154; 95% CI, 0.308-0.910; p<0.001) and cardiovascular death (NRI, 1.018; 95% CI, 0.680-1.356; p<0.001). Conclusions: In patients aged <65 years with primary MR, e' velocity served as an independent predictor of all-cause and cardiovascular deaths.

키워드

과제정보

The authors thank Professor Soon Young Hwang (Korea University Medical Center and Korea University Guro Hospital) for her expert advice on statistical assessments.

참고문헌

  1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005-11.
  2. Goel SS, Bajaj N, Aggarwal B, et al. Prevalence and outcomes of unoperated patients with severe symptomatic mitral regurgitation and heart failure: comprehensive analysis to determine the potential role of MitraClip for this unmet need. J Am Coll Cardiol 2014;63:185-6.
  3. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2022;43:561-632.
  4. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 2021;143:e35-71.
  5. Baumgartner H, Iung B, Otto CM. Timing of intervention in asymptomatic patients with valvular heart disease. Eur Heart J 2020;41:4349-56.
  6. Kim HM, Cho GY, Hwang IC, et al. Myocardial strain in prediction of outcomes after surgery for severe mitral regurgitation. JACC Cardiovasc Imaging 2018;11:1235-44.
  7. Choi YJ, Park J, Hwang D, et al. Network analysis of cardiac remodeling by primary mitral regurgitation emphasizes the role of diastolic function. JACC Cardiovasc Imaging 2022;15:974-86.
  8. Olson JJ, Costa SP, Young CE, Palac RT. Early mitral filling/diastolic mitral annular velocity ratio is not a reliable predictor of left ventricular filling pressure in the setting of severe mitral regurgitation. J Am Soc Echocardiogr 2006;19:83-7.
  9. Bruch C, Stypmann J, Gradaus R, Breithardt G, Wichter T. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. Am J Cardiol 2004;93:324-8.
  10. Rossi A, Cicoira M, Golia G, Anselmi M, Zardini P. Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: the advantage of end-diastolic markers. J Am Soc Echocardiogr 2001;14:562-8.
  11. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997;30:474-80.
  12. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
  13. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2019;32:1-64.
  14. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802.
  15. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29:277-314.
  16. Haruki N, Takeuchi M, Gerard O, et al. Accuracy of measuring mitral annular velocity by 2D speckle tracking imaging. J Cardiol 2009;53:188-95.
  17. Grigioni F, Clavel MA, Vanoverschelde JL, et al. The MIDA mortality risk score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation. Eur Heart J 2018;39:1281-91.
  18. Harrell FE. Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. New York (NY): Springer International Publishing; 2015. 
  19. Suri RM, Vanoverschelde JL, Grigioni F, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA 2013;310:609-16.
  20. Corin WJ, Murakami T, Monrad ES, Hess OM, Krayenbuehl HP. Left ventricular passive diastolic properties in chronic mitral regurgitation. Circulation 1991;83:797-807.
  21. Zaid RR, Barker CM, Little SH, Nagueh SF. Pre- and post-operative diastolic dysfunction in patients with valvular heart disease: diagnosis and therapeutic implications. J Am Coll Cardiol 2013;62:1922-30.
  22. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010;85:483-500.
  23. Tsutsui H, Urabe Y, Mann DL, et al. Effects of chronic mitral regurgitation on diastolic function in isolated cardiocytes. Circ Res 1993;72:1110-23.
  24. Barbone A, Oz MC, Burkhoff D, Holmes JW. Normalized diastolic properties after left ventricular assist result from reverse remodeling of chamber geometry. Circulation 2001;104:I229-32.
  25. Borg AN, Harrison JL, Argyle RA, Pearce KA, Beynon R, Ray SG. Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation. Eur J Echocardiogr 2010;11:523-9. 
  26. Hollingsworth KG, Blamire AM, Keavney BD, Macgowan GA. Left ventricular torsion, energetics, and diastolic function in normal human aging. Am J Physiol Heart Circ Physiol 2012;302:H885-92.
  27. Gao X, Jakovljevic DG, Beard DA. Cardiac metabolic limitations contribute to diminished performance of the heart in aging. Biophys J 2019;117:2295-302.
  28. Kitzman DW. Diastolic dysfunction in the elderly. Genesis and diagnostic and therapeutic implications. Cardiol Clin 2000;18:597-617.
  29. Yamada H, Oki T, Mishiro Y, et al. Effect of aging on diastolic left ventricular myocardial velocities measured by pulsed tissue Doppler imaging in healthy subjects. J Am Soc Echocardiogr 1999;12:574-81.
  30. Markar SR, Sadat U, Edmonds L, Nair SK. Mitral valve repair versus replacement in the elderly population. J Heart Valve Dis 2011;20:265-71.
  31. Mitter SS, Shah SJ, Thomas JD. A test in context: E/A and E/e' to assess diastolic dysfunction and LV filling pressure. J Am Coll Cardiol 2017;69:1451-64.