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Impact of concomitant mitral and tricuspid regurgitation in patients with significant chronic aortic regurgitation
Session:
Posters (Sessão 1 - Écran 8) - Doença Valvular 1 - Vários
Speaker:
Gualter Santos Silva
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Gualter Santos Silva; Mariana Brandão; Mariana Silva; Pedro Queirós; Diogo Ferreira; Ricardo Fontes-Carvalho; Francisco Sampaio
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Clinical outcomes of patients with significant chronic aortic regurgitation (AR) may be affected by a series of “downstream” pathophysiological cardiac consequences. However, the impact of cardiac consequences of AR beyond those related to the left ventricle (i.e., dilation and systolic dysfunction) are not well established. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> Our aim was to investigate the prognostic impact of concomitant significant mitral regurgitation (MR) and tricuspid regurgitation (TR) in patients with significant AR.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Clinical, echocardiographic and outcome data of patients with moderate-severe AR who underwent transthoracic echocardiography between January 2014 and September 2019 were retrospectively analysed. According to echocardiographic characteristics (i.e. significant mitral and/or tricuspid regurgitation) patients were divided into three groups: pure AR, AR + MR and AR + MR + TR. The primary endpoint was all-cause mortality. Exclusion criteria were severe aortic stenosis and previous valve repair or replacement. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Of 571 patients enrolled (median age 73, IQR 62 – 80 years, 51% male), 469 (82%) had pure AR, 57 (10%) had AR + MR and 45 (8%) had AR + MR + TR. Median follow-up time of 39.5 months (IQR 22.2 to 61.0). At baseline, groups exhibited differences in age (69 ± 14, 75 ± 10 and 77 ± 11 years, respectively), male sex (45%, 37% and 33%), history of smoking (19%, 11% and 9%), atrial fibrillation (22%, 34% and 67%), LV dysfunction (18%, 40% and 44%), LV end-systolic volume (62 ± 37, 83 ± 63 and 69 ± 38 mL) and RV dysfunction (1%, 11% and 16%). At the end of follow-up, cumulative death was significantly higher in AR + MR and AR + MR + TR patients (log rank <0.001; figure 1). On multivariable analysis (adjusted for age, sex, atrial fibrillation, history of smoking, LV dysfunction, LV end-systolic volume, right ventricle dysfunction and aortic valve replacement), compared with pure AR, AR + MR + TR was independently associated with all-cause mortality (HR: 2.16; 95% CI 1.26 to 3.70; p = 0.005).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>Our study showed that concomitant significant valvular damage is not uncommon (18%). As compared with pure AR, AR + MR + TR carry a survival penalty and represents an advanced stage within the AR clinical spectrum. These downstream consequences beyond the left ventricle should be considered to establish the timing of intervention, even in patients with moderate to severe AR, in whom current guidelines do not recommend AVR.</span></span></p>
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