Impact of Frailty and Mitral Valve Surgery on Outcomes of Severe Mitral Stenosis Due to Mitral Annular Calcification

Autor: Gösta B. Pettersson, A. Marc Gillinov, Yoshihito Saijo, Richard A. Grimm, Maria Vega Brizneda, Reza Reyaldeen, Nicholas Chan, Brian P. Griffin, Christine Jellis, Shinya Unai, Hassan Mehmood Lak, Bo Xu
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Mitral Valve Annuloplasty
Heart Valve Diseases
Angiotensin-Converting Enzyme Inhibitors
Comorbidity
Conservative Treatment
Severity of Illness Index
Angiotensin Receptor Antagonists
Hemoglobins
Internal medicine
Mitral valve
Cause of Death
Clinical endpoint
Medicine
Humans
Mitral Valve Stenosis
Mortality
Propensity Score
Serum Albumin
Aged
Proportional Hazards Models
Aged
80 and over
Heart Valve Prosthesis Implantation
biology
Frailty
business.industry
Proportional hazards model
Hazard ratio
Calcinosis
Angiotensin-converting enzyme
Middle Aged
medicine.disease
Prognosis
Confidence interval
Stenosis
medicine.anatomical_structure
Propensity score matching
biology.protein
Cardiology
Mitral Valve
Female
Sedentary Behavior
Cardiology and Cardiovascular Medicine
business
Zdroj: The American journal of cardiology. 160
ISSN: 1879-1913
Popis: We sought to evaluate the outcomes of patients with severe mitral stenosis (MS) resulting from mitral annular calcification and assessed the prognostic impact of co-morbidities and frailty in guiding management. Among 6,915 patients with calcific MS who underwent echocardiography between January 2011 and March 2020, a total of 283 patients with severe calcific MS were retrospectively enrolled. We calculated the Charlson co-morbidity index (CCI). Frailty was scored from 0 to 3 points, with 1 point each assigned for reduced hemoglobin, reduced albumin, and inactivity. The primary end point was all-cause death. The mean age was 72 ± 11 years. The mean mitral valve (MV) area was 1.1 ± 0.4 cm2, and the mean transmitral gradient was 12 ± 4 mm Hg. Although 33% of the patients underwent MV intervention, 67% were conservatively managed. During a median follow-up of 360 days, 35% died. Patients who underwent MV intervention had an improved prognosis compared with those who were treated conservatively, even after propensity score matching. On multivariate Cox regression analysis, higher CCI (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.04 to 1.38, p = 0.011) and frailty score (HR 1.58, 95% CI 1.12 to 2.23, p = 0.01) were predictors of all-cause mortality, and MV intervention (HR 0.45, 95% CI 0.25 to 0.83, p = 0.011) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker use (HR 0.39, 95% CI 0.20 to 0.79, p = 0.009) were associated with an improved prognosis. In conclusion, patients with severe calcific MS were often frail with multiple co-morbidities and were often managed conservatively. Higher CCI and worse frailty were associated with worse prognosis, regardless of the treatment strategy. MV intervention for select patients was associated with improved prognosis.
Databáze: OpenAIRE
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