The Prognostic Value of Pulmonary Venous Flow Reversal in Patients with Significant Degenerative Mitral Regurgitation

Author:

Shechter Alon123ORCID,Butcher Steele C.4ORCID,Siegel Robert J.35,Awesat Jenan12,Abitbol Merry12,Vaturi Mordehay12ORCID,Sagie Alex12,Kornowski Ran12ORCID,Shapira Yaron12,Yedidya Idit12ORCID

Affiliation:

1. Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel

2. Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

3. Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA

4. Department of Cardiology, Royal Perth Hospital, Perth, WA 6000, Australia

5. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA

Abstract

Background: The prognostic significance of pulmonary venous (PV) flow reversal in degenerative mitral regurgitation (dMR) is not well-established. Objective: We aimed to assess whether reversed PV flow is associated with adverse outcomes in patients with significant dMR. Methods: We retrospectively analyzed consecutive patients referred to a tertiary center for evaluation of dMR of greater than moderate degree, who had normal sinus rhythm, had a left ventricular ejection fraction of above 60%, and did not suffer from any other major valvular disorders. The primary outcome was the combined rate of all-cause mortality, mitral intervention, or new-onset atrial fibrillation (AF) at 5 years following index echocardiogram. Secondary outcomes included individual components of the primary outcome. Results: Overall, 135 patients (median age 68 (IQR, 58–74) years; 93 (68.9%) males; 89 (65.9%) with severe MR) met the inclusion criteria and were followed for 115.2 (IQR, 60.0–155.0) months. Patients with a reversed PV flow pattern (PVFP) (n = 34) more often presented with severe MR compared to those with a normal (n = 49) and non-reversed PVFP (n = 101) (RR = 2.03 and 1.59, respectively, all p < 0.001). At 5 years, they experienced the highest cumulative incidence of the primary outcome (80.2% vs. 59.2% and 67.3%, p = 0.008 and 0.018, respectively). Furthermore, a reversed PVFP was independently associated with a higher risk of the primary outcome compared to normal PVFP (HR 2.53, 95% CI 1.21–5.31, p = 0.011) and non-reversed PVFP (HR 2.14, 95% CI 1.12–4.10, p = 0.022). Conclusion: PV flow reversal is associated with a worse 5-year composite of mortality, mitral intervention, or AF in patients with significant dMR.

Publisher

MDPI AG

Subject

Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics

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