Clinical significance of myocardial contraction fraction in significant primary mitral regurgitation |
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| Affiliation: | 1. GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/ Lille Catholic hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France;2. Institut universitaire de cardiologie et de pneumologie de Québec / Québec Heart & Lung Institute, Laval University, Québec City QC G1V 4G5, Québec, Canada;3. Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, 59000 Lille, France;1. Sorbonne Université, ACTION Study Group, Inserm UMRS 1166, Hôpital Pitié-Salpêtrière, AP–HP, 75013 Paris, France;2. StatEthic, 92300 Levallois-Perret, France;3. Unité de recherche clinique, ACTION Study Group, Hôpital Fernand-Widal, AP–HP, 75010 Paris, France;4. Statistique, Analyse et Modélisation Multidisciplinaire (SAMM), EA 4543, Université Paris 1 Panthéon Sorbonne, 75013 Paris, France;1. Emergency Department, Toulouse University Hospital, 31059 Toulouse, France;2. Intensive Cardiac Care Unit, Cardiology Department, Toulouse University Hospital, 31059 Toulouse, France;3. CERPOP, Toulouse University, Inserm, UPS, Toulouse, France;1. Service de médecine intensive réanimation, département médico-universitaire APPROCHES, hôpital Tenon, AP–HP, Sorbonne université, 75020 Paris, France;2. Groupe de recherche clinique CARMAS, université Paris-Est Créteil, 94010 Créteil, France;3. Department of Cardiology, UNICO Cardio-Oncology Program, hôpital Saint-Antoine, AP–HP, 75012 Paris, France;4. Inserm U 856, 75013 Paris, France;5. Division of Intensive Care, Department of Acute Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland;6. Laboratory of Nephrology, Department of Medicine, University Hospitals of Geneva, 1205 Geneva; and Department of Cell Physiology, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland;7. Service de médecine intensive réanimation, hôpital Saint-Antoine, AP–HP, Sorbonne université, 75012 Paris, France;8. Service de médecine intensive réanimation, département médico-universitaire médecine, hôpitaux universitaires Henri Mondor-Albert Chenevier, AP–HP, 94000 Créteil, France;9. Service de médecine intensive réanimation, centre hospitalier melun, groupe hospitalier Sud Ile-de-France, 77000 Melun, France;10. Réanimation médicale et toxicologique, hôpital Lariboisière, AP–HP, université de Paris, Inserm UMRS-1144, 75010 Paris, France;11. UMR-S ICAN 1166, Sorbonne université, 75013 Paris, France;1. EA CHIMERE 7516, department of vascular medicine, Picardie Jules Verne university, CHU Amiens Picardie, 80054 Amiens, France;2. EA HEMATIM 4666, department of genetics, Picardie Jules Verne university, CHU Amiens Picardie, 80054 Amiens, France;3. Thrombosis and atherosclerosis research unit, vessels and blood institute (IVS), anticoagulation clinic (CREATIF), Lariboisière hospital, AP–HP, 75010 Paris, France;4. Department of cardiology, CHU Grenoble, 38700 La Tronche, France;5. Department of cardiology, hospital of Antibes, 06600 Antibes, France;6. Department of gynaecology, Cochin hospital, AP–HP, 75014 Paris, France;7. French Society of cardiology, 75012 Paris, France;8. EA 3878, CIC Inserm 1412, FCRIN INNOVTE, department of internal medicine and pneumology, university of Western Brittany, CHU Brest, 29609 Brest, France;9. Institute of cardiology, La Pitié-Salpêtrière hospital, Sorbonne university, AP–HP, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France;1. Département de cardiologie, CHU Timone, 13005 Marseille, France;2. C2VN, Aix-Marseille université, Inserm, INRA, 13005 Marseille, France;3. Faculté de médecine, Aix-Marseille université, 13385 Marseille, France;4. Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France;5. EA4245 Transplantation immunité inflammation, université de Tours, 37032 Tours, France;6. Département de cardiologie, CHU Nord, 13015 Marseille, France;7. Service d’information médicale, d’épidémiologie et d’économie de la santé, centre hospitalier universitaire et Faculté de médecine, EA7505, université de Tours, 37044 Tours, France;1. Université Paris Cité, Inserm, PARCC, 75015 Paris, France;2. Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France;3. Department of Cardiology, Cochin Hospital, AP-HP, 75015 Paris, France;4. Department of Cardiology, Necker Hospital, AP-HP, 75015 Paris, France;5. Department of Geriatry, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France;6. Department of Neurology, Saint Anne Hospital, Université Paris-Cité, 75014 Paris, France;7. Emergency Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France;8. Department of Radiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France |
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| Abstract: | BackgroundThe optimal timing for mitral valve (MV) surgery in asymptomatic patients with primary mitral regurgitation (MR) remains a matter of debate. Myocardial contraction fraction (MCF) − the ratio of the left ventricular (LV) stroke volume to that of the myocardial volume − is a volumetric measure of LV myocardial shortening independent of size or geometry.AimTo assess the relationship between MCF and outcome in patients with significant chronic primary MR due to prolapse managed in contemporary practice.MethodsClinical, Doppler-echocardiographic and outcome data prospectively collected in 174 patients (mean age 62 years, 27% women) with significant primary MR and no or mild symptoms were analysed. The impact of MCF< or ≥30% on cardiac events (cardiovascular death, acute heart failure or MV surgery) was studied.ResultsDuring an estimated median follow-up of 49 (22–77) months, cardiac events occurred in 115 (66%) patients. The 4-year estimates of survival free from cardiac events were 21 ± 5% for patients with MCF <30% and 40 ± 6% for those with ≥30% (P < 0.001). MCF <30% was associated with a considerable increased risk of cardiac events after adjustment for established clinical risk factors, MR severity and current recommended class I triggers for MV surgery (adjusted hazard ratio: 2.33, 95% confidence interval: 1.51−3.58; P < 0.001). Moreover, MCF < 30% improved the predictive performance of models, with better global fit, reclassification and discrimination.ConclusionsMCF < 30% is strongly associated with occurrence of cardiac events in patients with significant primary MR due to prolapse. Further studies are needed to assess the direct impact of MCF on patient management and outcomes. |
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| Keywords: | Primary mitral regurgitation Myocardial contraction fraction Echocardiography Outcome CI" },{" #name" :" keyword" ," $" :{" id" :" kw0030" }," $$" :[{" #name" :" text" ," _" :" confidence interval EuroSCORE II" },{" #name" :" keyword" ," $" :{" id" :" kw0040" }," $$" :[{" #name" :" text" ," _" :" Logistic European System for Cardiac Operative Risk Evaluation II HR" },{" #name" :" keyword" ," $" :{" id" :" kw0050" }," $$" :[{" #name" :" text" ," _" :" hazard ratio IQR" },{" #name" :" keyword" ," $" :{" id" :" kw0060" }," $$" :[{" #name" :" text" ," _" :" interquartile range LV" },{" #name" :" keyword" ," $" :{" id" :" kw0070" }," $$" :[{" #name" :" text" ," _" :" left ventricle/ventricular MCF" },{" #name" :" keyword" ," $" :{" id" :" kw0080" }," $$" :[{" #name" :" text" ," _" :" myocardial contraction fraction MR" },{" #name" :" keyword" ," $" :{" id" :" kw0090" }," $$" :[{" #name" :" text" ," _" :" mitral regurgitation MV" },{" #name" :" keyword" ," $" :{" id" :" kw0100" }," $$" :[{" #name" :" text" ," _" :" mitral valve NYHA" },{" #name" :" keyword" ," $" :{" id" :" kw0110" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association |
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