Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation |
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| Authors: | Francesco Grigioni Giovanni Benfari Jean-Louis Vanoverschelde Christophe Tribouilloy Jean-Francois Avierinos Francesca Bursi Rakesh M. Suri Federico Guerra Agnés Pasquet Dan Rusinaru Emanuela Marcelli Alexis Théron Andrea Barbieri Hector Michelena Siham Lazam Catherine Szymanski Vuyisile T. Nkomo Alessandro Capucci L. Bacchi-Reggiani |
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| Affiliation: | 1. Cardiovascular Department, University Campus Bio-Medico, Rome, Italy;2. Cardiovascular Division, Mayo Clinic, Mayo Medical School, Rochester, Minnesota;3. Cardiovascular Division, University Catholic of Louvain, Louvain, Belgium;4. Department of Cardiology, Amiens University Hospital, Amiens, France, and EA 7517 MP3CV Université de Picardie Jules verne University Hospital, Amiens, France;5. Cardiovascular Division, Aix-Marseille Université, INSERM MMG U1251, Marseille, France;6. Division of Cardiology, San Paolo Hospital, Heart and Lung Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy;7. Cardiac Surgery Division, Cleveland Clinic and Cleveland Clinic Abu Dhabi, Cleveland, Ohio;8. Cardiovascular Department, University Politecnica delle Marche, Ancona, Italy;9. Cardiovascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy;10. Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy |
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| Abstract: | BackgroundScientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery.ObjectivesThis study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term.MethodsPatients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed.ResultsAmong 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values <0.0001). Surgery (n = 1,889, repair 88%) was associated with better survival versus medical management, regardless of all baseline characteristics and rhythm (adjusted hazard ratio: 0.26; 95% confidence interval: 0.23 to 0.30; p < 0.0001) but post-surgical outcome remained affected by AF (10-year post-surgical survival in SR and in paroxysmal and persistent AF was 82 ± 1%, 70 ± 4%, and 57 ± 3%, respectively; p < 0.0001).ConclusionsAF is a frequent occurrence at DMR diagnosis. Although AF is associated with older age and more severe presentation of DMR, it is independently associated with excess mortality long-term after diagnosis. Surgery is followed by improved survival in each cardiac rhythm subset, but persistence of excess risk is observed for each type of AF. Our study indicates that detection of AF, even paroxysmal, should trigger prompt consideration for surgery. |
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| Keywords: | atrial fibrillation mitral regurgitation mitral repair percutaneous treatment prognosis surgery AF atrial fibrillation CVD cardiovascular death DMR degenerative mitral regurgitation SR normal sinus rhythm |
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