Background-Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. Methods and Results-The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA<55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P<0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008). Conclusions-In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. © 2011 American Heart Association, Inc.

Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study / Rusinaru, Dan; Tribouilloy, Christophe; Grigioni, Francesco; Avierinos, Jean François; Suri, Rakesh M.; Barbieri, Andrea; Szymanski, Catherine; Ferlito, Marinella; Michelena, Hector; Tafanelli, Laurence; Bursi, Francesca; Mezghani, Sonia; Branzi, Angelo; Habib, Gilbert; Modena, Maria G.; Enriquez-Sarano, Maurice. - In: CIRCULATION. CARDIOVASCULAR IMAGING. - ISSN 1941-9651. - 4:5(2011), pp. 473-481. [10.1161/CIRCIMAGING.110.961011]

Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study

BARBIERI, ANDREA;Bursi, Francesca;Modena, Maria G.;
2011

Abstract

Background-Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. Methods and Results-The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA<55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P<0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008). Conclusions-In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. © 2011 American Heart Association, Inc.
2011
4
5
473
481
Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets results from a large international multicenter study / Rusinaru, Dan; Tribouilloy, Christophe; Grigioni, Francesco; Avierinos, Jean François; Suri, Rakesh M.; Barbieri, Andrea; Szymanski, Catherine; Ferlito, Marinella; Michelena, Hector; Tafanelli, Laurence; Bursi, Francesca; Mezghani, Sonia; Branzi, Angelo; Habib, Gilbert; Modena, Maria G.; Enriquez-Sarano, Maurice. - In: CIRCULATION. CARDIOVASCULAR IMAGING. - ISSN 1941-9651. - 4:5(2011), pp. 473-481. [10.1161/CIRCIMAGING.110.961011]
Rusinaru, Dan; Tribouilloy, Christophe; Grigioni, Francesco; Avierinos, Jean François; Suri, Rakesh M.; Barbieri, Andrea; Szymanski, Catherine; Ferli...espandi
File in questo prodotto:
File Dimensione Formato  
473.full.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 686.9 kB
Formato Adobe PDF
686.9 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1148622
Citazioni
  • ???jsp.display-item.citation.pmc??? 31
  • Scopus 106
  • ???jsp.display-item.citation.isi??? 101
social impact