Degenerative Mitral Regurgitation Outcomes in Asian Compared With European-American Institutions.

Autor:	Hamid N; National Heart Centre Singapore, Singapore.; New York Presbyterian Hospital, Columbia University Medical Center, New York, New York., Bursi F; University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy., Benfari G; Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA.; University of Verona, Department of Medicine, Section of cardiology, Verona, Italy., Vanoverschelde JL; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium., Tribouilloy C; Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France., Biagini E; Cardiovascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy., Avierinos JF; Cardiovascular Division, Aix-Marseille Université, INSERM MMG U1251, Marseille, France., Barbieri A; Divison of Cardiology, Department of Diagnostics, Clinical and Health Public, University of Modena, University of Modena and Reggio Emilia, Modena, Italy., Fan Y; Shanghai Chest Hospital, Shanghai, P.R. China., Guerra F; Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona, Italy., Leng CY; National Heart Centre Singapore, Singapore., Essayagh B; Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA., Pasquet A; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium., Szymansky C; Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France., Théron A; Cardiovascular Division, Aix-Marseille Université, INSERM MMG U1251, Marseille, France., Michelena HI; Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA., Nkomo VT; Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA., Vancraeynest D; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium., Rusinaru D; Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules Verne University Hospital, Amiens, France., Grigioni F; Cardiovascular Department, University Campus Bio-Medico, Rome, Italy., Enriquez-Sarano ML; Department of Cardiovascular Medicine, Mayo Clinic, Rochester Minnesota, USA.; Minneapolis Heart Institute, Minneapolis, Minnesota, USA., Pin DZ; National Heart Centre Singapore, Singapore., Pui-Wai Lee A; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong, P.R. China.
Jazyk:	angličtina
Zdroj:	JACC. Asia [JACC Asia] 2024 May 21; Vol. 4 (6), pp. 468-480. Date of Electronic Publication: 2024 May 21 (Print Publication: 2024).
DOI:	10.1016/j.jacasi.2024.03.003
Abstrakt:	Background: Clinical outcome and interventional thresholds for degenerative mitral regurgitation (DMR) were developed in studies of patients at European and American institutions (EAIs), but little is known about patients at Asian institutions (AsIs). Objectives: This study sought to contrast DMR presentation/management/outcomes of AsI patients vs EAI patients. Methods: Patients with DMR due to flail leaflet from Hong Kong and Singapore (AsI cohort, n = 737) were compared with EAI patients (n = 682) enrolled in the MIDA (Mitral regurgitation International Database) registry with similar eligibility criteria. Results: AsI patients presented similar DMR lesion/consequences vs EAI patients, but they were younger, with fewer symptoms (74% vs 44% Class I), more sinus rhythm (83% vs 69%), and lower EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) (0.9 ± 0.5 vs 1.4 ± 1.5; all P  < 0.0001). Imaging showed smaller absolute left atrial/ventricular dimensions in AsI patients, belying cardiac dilatation with larger body surface area-indexed diameters (all P  < 0.01). Surgical/interventional mitral repair was similarly predominant (90% vs 91%; P  = 0.47), and early repair was similarly beneficial (for AsI patients, adjusted HR: 0.28; 95% CI: 0.16-0.49; for EAI patients, HR: 0.32; 95% CI: 0.20-0.49; both P  < 0.0001). However, AsI patients underwent fewer interventions (55% ± 2% vs 77% ± 2% at 1 year; P  < 0.0001) and incurred excess mortality (adjusted HR: 1.60 [95% CI: 1.13-2.27] vs EAI patients; P  = 0.008) at long-term postdiagnosis. Propensity score matching (434 patient pairs), which balanced all clinical characteristics, confirmed that there was undertreatment and excess mortality in the long term in AsI patients with DMR ( P  < 0.0001). Conclusions: Imaging may underestimate volume overload in AsI patients due to smaller cardiac cavities related to smaller body size compared with EAI patients with similar mitral lesions and DMR severity. AsI patients enjoy similar mitral repair predominance and early intervention benefits but undergo fewer mitral interventions than EAI patients and incur subsequent excess mortality, suggesting the need to account for imaging and cultural specificity to improve DMR outcomes worldwide. Competing Interests: Dr Enriquez-Sarano has received personal fees from Edwards LLC, ChemImage Inc, and CryoLife Inc, outside the submitted work. Dr Ding has received personal fees from GE Healthcare; and nonfinancial support from Phillips Healthcare, outside the submitted work. Dr Lee has received grant support from Abbott, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2024 The Authors.)
Databáze:	MEDLINE
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