Prognostic importance of the transmitral pressure gradient in mitral annular calcification with associated mitral valve dysfunction
| Autor: | Evin Yucel, Timothy W. Churchill, Michael H. Picard, Mayooran Namasivayam, Wei He, Yasufumi Nagata, Carl T. Andrews, Robert A. Levine, Philippe Bertrand, Judy Hung, Samuel Bernard, Arthur E. Weyman |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Mitral annular calcification Heart Valve Diseases 030204 cardiovascular system & hematology Coronary artery disease 03 medical and health sciences 0302 clinical medicine Clinical Research Internal medicine Diabetes mellitus Mitral valve Medicine Mitral Valve Stenosis Humans 030212 general & internal medicine Pressure gradient Aged Aged 80 and over Mitral regurgitation business.industry Calcinosis Mitral Valve Insufficiency medicine.disease Prognosis medicine.anatomical_structure Treatment Outcome Concomitant Cardiology Mitral Valve Female Cardiology and Cardiovascular Medicine business Kidney disease |
| Zdroj: | Eur Heart J |
| ISSN: | 1522-9645 |
| Popis: | Aims The aim of this study was to define the natural history of patients with mitral annular calcification (MAC)-related mitral valve dysfunction and to assess the prognostic importance of mean transmitral pressure gradient (MG) and impact of concomitant mitral regurgitation (MR). Methods and results The institutional echocardiography database was examined from 2001 to 2019 for all patients with MAC and MG ≥3 mmHg. A total of 5754 patients were stratified by MG in low (3–5 mmHg, n = 3927), mid (5–10 mmHg, n = 1476), and high (≥10 mmHg, n = 351) gradient. The mean age was 78 ± 11 years, and 67% were female. MR was none/trace in 32%, mild in 42%, moderate in 23%, and severe in 3%. Primary outcome was all-cause mortality, and outcome models were adjusted for age, sex, and MAC-related risk factors (hypertension, diabetes, coronary artery disease, chronic kidney disease). Survival at 1, 5, and 10 years was 77%, 42%, and 18% in the low-gradient group; 73%, 38%, and 17% in the mid-gradient group; and 67%, 25%, and 11% in the high-gradient group, respectively (log-rank P Conclusion In MAC-related mitral valve dysfunction, mean transmitral gradient is associated with increased mortality after adjustment for age, sex, and MAC-related risk factors. Concomitant MR is associated with excess mortality in low-gradient ranges (3–5 mmHg) but gradually loses prognostic importance at higher gradients, indicating prognostic utility of transmitral gradient in MAC regardless of MR severity. |
| Databáze: | OpenAIRE |
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