Cargando…
Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study
OBJECTIVE: We sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities. METHODS: This was a retrospective matched cohor...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120438/ https://www.ncbi.nlm.nih.gov/pubmed/25034628 http://dx.doi.org/10.1136/bmjopen-2014-004984 |
_version_ | 1782329088964296704 |
---|---|
author | Prakash, Roshan Horsfall, Matthew Markwick, Andrew Pumar, Marsus Lee, Leong Sinhal, Ajay Joseph, Majo X Chew, Derek P |
author_facet | Prakash, Roshan Horsfall, Matthew Markwick, Andrew Pumar, Marsus Lee, Leong Sinhal, Ajay Joseph, Majo X Chew, Derek P |
author_sort | Prakash, Roshan |
collection | PubMed |
description | OBJECTIVE: We sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities. METHODS: This was a retrospective matched cohort study using a clinical-echocardiography reporting database linked to a clinical and administrative database in an Australian tertiary hospital. We identified our study cohort (patients with significant MR) and control cohort (without MR) on transthoracic echocardiographies performed between 2005 and 2010. The main outcome measures were mortality and heart failure rehospitalisation. A Cox proportional hazards model was used to adjust for clinical covariates and the ‘win ratio’ methodology was utilised to estimate the impact of MR on main outcomes. RESULTS: A total of 218 matched patients with and without significant MR were followed-up for 1 year. Significant MR was associated with an adjusted HR for mortality of 1.83 (95% CI 1.28 to 2.62, p<0.001). The win ratio for death and death or heart failure readmission was 0.57 (95% CI 0.40 to 0.78, p=0.0002) and 0.53 (95% CI 0.39 to 0.71, p<0.0001), respectively. Significant MR with left ventricular (LV) systolic dysfunction and age between 75 and 85 years were associated with a substantial reduction in median survival by 2.3 years. Significant MR with LV systolic dysfunction, age beyond 85 and advance comorbidities were associated with a lesser reduction in median survival by 0.2 years. CONCLUSIONS: Significant MR in patients with multiple comorbidities leads to increase in death and heart failure rehospitalisation with reduced estimated median survival. However, its impact diminishes with increasing comorbidities. |
format | Online Article Text |
id | pubmed-4120438 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-41204382014-08-05 Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study Prakash, Roshan Horsfall, Matthew Markwick, Andrew Pumar, Marsus Lee, Leong Sinhal, Ajay Joseph, Majo X Chew, Derek P BMJ Open Cardiovascular Medicine OBJECTIVE: We sought to objectively quantify the independent impact of significant mitral regurgitation (MR) on prognosis in patients with multiple comorbidities and ascertain the extent to which median survival is affected by increasing comorbidities. METHODS: This was a retrospective matched cohort study using a clinical-echocardiography reporting database linked to a clinical and administrative database in an Australian tertiary hospital. We identified our study cohort (patients with significant MR) and control cohort (without MR) on transthoracic echocardiographies performed between 2005 and 2010. The main outcome measures were mortality and heart failure rehospitalisation. A Cox proportional hazards model was used to adjust for clinical covariates and the ‘win ratio’ methodology was utilised to estimate the impact of MR on main outcomes. RESULTS: A total of 218 matched patients with and without significant MR were followed-up for 1 year. Significant MR was associated with an adjusted HR for mortality of 1.83 (95% CI 1.28 to 2.62, p<0.001). The win ratio for death and death or heart failure readmission was 0.57 (95% CI 0.40 to 0.78, p=0.0002) and 0.53 (95% CI 0.39 to 0.71, p<0.0001), respectively. Significant MR with left ventricular (LV) systolic dysfunction and age between 75 and 85 years were associated with a substantial reduction in median survival by 2.3 years. Significant MR with LV systolic dysfunction, age beyond 85 and advance comorbidities were associated with a lesser reduction in median survival by 0.2 years. CONCLUSIONS: Significant MR in patients with multiple comorbidities leads to increase in death and heart failure rehospitalisation with reduced estimated median survival. However, its impact diminishes with increasing comorbidities. BMJ Publishing Group 2014-07-17 /pmc/articles/PMC4120438/ /pubmed/25034628 http://dx.doi.org/10.1136/bmjopen-2014-004984 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ |
spellingShingle | Cardiovascular Medicine Prakash, Roshan Horsfall, Matthew Markwick, Andrew Pumar, Marsus Lee, Leong Sinhal, Ajay Joseph, Majo X Chew, Derek P Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title | Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title_full | Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title_fullStr | Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title_full_unstemmed | Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title_short | Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study |
title_sort | prognostic impact of moderate or severe mitral regurgitation (mr) irrespective of concomitant comorbidities: a retrospective matched cohort study |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120438/ https://www.ncbi.nlm.nih.gov/pubmed/25034628 http://dx.doi.org/10.1136/bmjopen-2014-004984 |
work_keys_str_mv | AT prakashroshan prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT horsfallmatthew prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT markwickandrew prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT pumarmarsus prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT leeleong prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT sinhalajay prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT josephmajox prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy AT chewderekp prognosticimpactofmoderateorseveremitralregurgitationmrirrespectiveofconcomitantcomorbiditiesaretrospectivematchedcohortstudy |