Cargando…

The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively...

Descripción completa

Detalles Bibliográficos
Autores principales: Shechter, Alon, Butcher, Steele C., Siegel, Robert J., Awesat, Jenan, Abitbol, Merry, Vaturi, Mordehay, Sagie, Alex, Kornowski, Ran, Shapira, Yaron, Yedidya, Idit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9965059/
https://www.ncbi.nlm.nih.gov/pubmed/36826545
http://dx.doi.org/10.3390/jcdd10020049
_version_ 1784896663293263872
author Shechter, Alon
Butcher, Steele C.
Siegel, Robert J.
Awesat, Jenan
Abitbol, Merry
Vaturi, Mordehay
Sagie, Alex
Kornowski, Ran
Shapira, Yaron
Yedidya, Idit
author_facet Shechter, Alon
Butcher, Steele C.
Siegel, Robert J.
Awesat, Jenan
Abitbol, Merry
Vaturi, Mordehay
Sagie, Alex
Kornowski, Ran
Shapira, Yaron
Yedidya, Idit
author_sort Shechter, Alon
collection PubMed
description Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: 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. Results: 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 p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 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, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 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.
format Online
Article
Text
id pubmed-9965059
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-99650592023-02-26 The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation Shechter, Alon Butcher, Steele C. Siegel, Robert J. Awesat, Jenan Abitbol, Merry Vaturi, Mordehay Sagie, Alex Kornowski, Ran Shapira, Yaron Yedidya, Idit J Cardiovasc Dev Dis Article Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: 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. Results: 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 p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 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, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 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. MDPI 2023-01-28 /pmc/articles/PMC9965059/ /pubmed/36826545 http://dx.doi.org/10.3390/jcdd10020049 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shechter, Alon
Butcher, Steele C.
Siegel, Robert J.
Awesat, Jenan
Abitbol, Merry
Vaturi, Mordehay
Sagie, Alex
Kornowski, Ran
Shapira, Yaron
Yedidya, Idit
The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9965059/
https://www.ncbi.nlm.nih.gov/pubmed/36826545
http://dx.doi.org/10.3390/jcdd10020049
work_keys_str_mv AT shechteralon theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT butchersteelec theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT siegelrobertj theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT awesatjenan theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT abitbolmerry theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT vaturimordehay theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT sagiealex theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT kornowskiran theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT shapirayaron theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT yedidyaidit theprognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT shechteralon prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT butchersteelec prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT siegelrobertj prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT awesatjenan prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT abitbolmerry prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT vaturimordehay prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT sagiealex prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT kornowskiran prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT shapirayaron prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation
AT yedidyaidit prognosticvalueofpulmonaryvenousflowreversalinpatientswithsignificantdegenerativemitralregurgitation