학술논문
Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction.
Document Type
Academic Journal
Author
Mori M; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.; Zogg CK; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Amabile A; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Fereydooni S; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Agarwal R; Joint Data Analytics Team, Yale New Haven Health System, New Haven, Connecticut, United States of America.; Weininger G; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Krane M; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.; Sugeng L; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America.; Yale Echocardiographic Core Laboratory, Yale-New Haven Health, New Haven, Connecticut, United States of America.; Geirsson A; Divison of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America.
Source
Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Natural history of atrial and ventricular secondary mitral regurgitation (SMR) is poorly understood. We compared the impact of the degree of SMR on survival between atrial and ventricular dysfunction.
Methods: We conducted a retrospective cohort study of patients who underwent echocardiography in a healthcare network between 2013-2018. We compared the survival of patients with atrial and ventricular dysfunction, using propensity scores developed from differences in patient demographics and comorbidities within SMR severity strata (none, mild, moderate or severe). We fitted Cox proportional hazards models to estimate the risk-adjusted hazards of death across different severities of SMR between patients with atrial and ventricular dysfunction.
Results: Of 11,987 patients included (median age 69 years [IQR 58-80]; 46% women), 6,254 (52%) had isolated atrial dysfunction, and 5,733 (48%) had ventricular dysfunction. 3,522 patients were matched from each arm using coarsened exact matching. Hazard of death in atrial dysfunction without SMR was comparable to ventricular dysfunction without SMR (HR 1.1, 95% CI 0.9-1.3). Using ventricular dysfunction without SMR as reference, hazards of death remained higher in ventricular dysfunction than in atrial dysfunction across increasing severities of SMR: mild SMR (HR 2.1, 95% CI 1.8-2.4 in ventricular dysfunction versus HR 1.7, 95%CI 1.5-2.0 in atrial dysfunction) and moderate/severe SMR (HR 2.8, 95%CI 2.4-3.4 versus HR 2.4, 95%CI 2.0-2.9).
Conclusions: SMR across all severities were associated with better survival in atrial dysfunction than in ventricular dysfunction, though the magnitude of the diminishing survival were similar between atrial and ventricular dysfunction in increasing severity of SMRs.
Competing Interests: Dr. Geirsson receives a consulting fee for being a member of the Medtronic Strategic Surgical Advisory Board. Dr Krane is a physician proctor and a member of the medical advisory board for JOMDD, a physician proctor for Peter Duschek, and has received speakers ‘honoraria from Medtronic and Terumo. Dr. Zogg is supported by NIH Medical Scientist Training Program Grant T32GM007205 and an F30 Award through the National Institute on Aging F30AG066371. The remaining authors have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2022 Mori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Methods: We conducted a retrospective cohort study of patients who underwent echocardiography in a healthcare network between 2013-2018. We compared the survival of patients with atrial and ventricular dysfunction, using propensity scores developed from differences in patient demographics and comorbidities within SMR severity strata (none, mild, moderate or severe). We fitted Cox proportional hazards models to estimate the risk-adjusted hazards of death across different severities of SMR between patients with atrial and ventricular dysfunction.
Results: Of 11,987 patients included (median age 69 years [IQR 58-80]; 46% women), 6,254 (52%) had isolated atrial dysfunction, and 5,733 (48%) had ventricular dysfunction. 3,522 patients were matched from each arm using coarsened exact matching. Hazard of death in atrial dysfunction without SMR was comparable to ventricular dysfunction without SMR (HR 1.1, 95% CI 0.9-1.3). Using ventricular dysfunction without SMR as reference, hazards of death remained higher in ventricular dysfunction than in atrial dysfunction across increasing severities of SMR: mild SMR (HR 2.1, 95% CI 1.8-2.4 in ventricular dysfunction versus HR 1.7, 95%CI 1.5-2.0 in atrial dysfunction) and moderate/severe SMR (HR 2.8, 95%CI 2.4-3.4 versus HR 2.4, 95%CI 2.0-2.9).
Conclusions: SMR across all severities were associated with better survival in atrial dysfunction than in ventricular dysfunction, though the magnitude of the diminishing survival were similar between atrial and ventricular dysfunction in increasing severity of SMRs.
Competing Interests: Dr. Geirsson receives a consulting fee for being a member of the Medtronic Strategic Surgical Advisory Board. Dr Krane is a physician proctor and a member of the medical advisory board for JOMDD, a physician proctor for Peter Duschek, and has received speakers ‘honoraria from Medtronic and Terumo. Dr. Zogg is supported by NIH Medical Scientist Training Program Grant T32GM007205 and an F30 Award through the National Institute on Aging F30AG066371. The remaining authors have nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2022 Mori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)