Progression of Mitral Regurgitation in Rheumatic Valve Disease: Role of Left Atrial Remodeling.

Autor:	Gomes NFA; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil., Silva VR; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil., Levine RA; Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Esteves WAM; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil., de Castro ML; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil., Passos LSA; The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States., Dal-Bianco JP; Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Pantaleão AN; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil., da Silva JLP; Department of Statistics, Federal University of Paraná, Curitiba, Brazil., Tan TC; Department of Cardiology, Blacktown Hospital, University of Western Sydney, Penrith, NSW, Australia., Dutra WO; Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, and National Institutes for Science and Technology, Belo Horizonte, Brazil., Aikawa E; The Center for Excellence in Vascular Biology, Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States., Hung J; Cardiac Ultrasound Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States., Nunes MCP; School of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Mar 11; Vol. 9, pp. 862382. Date of Electronic Publication: 2022 Mar 11 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.862382
Abstrakt:	Introduction: Mitral regurgitation (MR) is the most common valve abnormality in rheumatic heart disease (RHD) often associated with stenosis. Although the mechanism by which MR develops in RHD is primary, longstanding volume overload with left atrial (LA) remodeling may trigger the development of secondary MR, which can impact on the overall progression of MR. This study is aimed to assess the incidence and predictors of MR progression in patients with RHD. Methods: Consecutive RHD patients with non-severe MR associated with any degree of mitral stenosis were selected. The primary endpoint was a progression of MR, which was defined as an increase of one grade in MR severity from baseline to the last follow-up echocardiogram. The risk of MR progression was estimated accounting for competing risks. Results: The study included 539 patients, age of 46.2 ± 12 years and 83% were women. At a mean follow-up time of 4.2 years (interquartile range [IQR]: 1.2-6.9 years), 54 patients (10%) displayed MR progression with an overall incidence of 2.4 per 100 patient-years. Predictors of MR progression by the Cox model were age (adjusted hazard ratio [HR] 1.541, 95% CI 1.222-1.944), and LA volume (HR 1.137, 95% CI 1.054-1.226). By considering competing risk analysis, the direction of the association was similar for the rate (Cox model) and incidence (Fine-Gray model) of MR progression. In the model with LA volume, atrial fibrillation (AF) was no longer a predictor of MR progression. In the subgroup of patients in sinus rhythm, 59 had an onset of AF during follow-up, which was associated with progression of MR (HR 2.682; 95% CI 1.133-6.350). Conclusions: In RHD patients with a full spectrum of MR severity, progression of MR occurs over time is predicted by age and LA volume. LA enlargement may play a role in the link between primary MR and secondary MR in patients with RHD. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Gomes, Silva, Levine, Esteves, de Castro, Passos, Dal-Bianco, Pantaleão, da Silva, Tan, Dutra, Aikawa, Hung and Nunes.)
Databáze:	MEDLINE
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