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Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study.
Circ Cardiovasc Imaging. 2011 Sep; 4(5):473-81.CC

Abstract

BACKGROUND

Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study.

METHODS AND RESULTS

The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA <55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P>0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008).

CONCLUSIONS

In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction.

Authors+Show Affiliations

INSERM, ERI 12 and University Hospital Amiens, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21737598

Citation

Rusinaru, Dan, et al. "Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets: Results From a Large International Multicenter Study." Circulation. Cardiovascular Imaging, vol. 4, no. 5, 2011, pp. 473-81.
Rusinaru D, Tribouilloy C, Grigioni F, et al. Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. Circ Cardiovasc Imaging. 2011;4(5):473-81.
Rusinaru, D., Tribouilloy, C., Grigioni, F., Avierinos, J. F., Suri, R. M., Barbieri, A., Szymanski, C., Ferlito, M., Michelena, H., Tafanelli, L., Bursi, F., Mezghani, S., Branzi, A., Habib, G., Modena, M. G., & Enriquez-Sarano, M. (2011). Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. Circulation. Cardiovascular Imaging, 4(5), 473-81. https://doi.org/10.1161/CIRCIMAGING.110.961011
Rusinaru D, et al. Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets: Results From a Large International Multicenter Study. Circ Cardiovasc Imaging. 2011;4(5):473-81. PubMed PMID: 21737598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study. AU - Rusinaru,Dan, AU - Tribouilloy,Christophe, AU - Grigioni,Francesco, AU - Avierinos,Jean François, AU - Suri,Rakesh M, AU - Barbieri,Andrea, AU - Szymanski,Catherine, AU - Ferlito,Marinella, AU - Michelena,Hector, AU - Tafanelli,Laurence, AU - Bursi,Francesca, AU - Mezghani,Sonia, AU - Branzi,Angelo, AU - Habib,Gilbert, AU - Modena,Maria G, AU - Enriquez-Sarano,Maurice, AU - ,, Y1 - 2011/07/07/ PY - 2011/7/9/entrez PY - 2011/7/9/pubmed PY - 2011/11/9/medline SP - 473 EP - 81 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 4 IS - 5 N2 - BACKGROUND: Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. METHODS AND RESULTS: The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA <55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P>0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008). CONCLUSIONS: In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/21737598/Left_atrial_size_is_a_potent_predictor_of_mortality_in_mitral_regurgitation_due_to_flail_leaflets:_results_from_a_large_international_multicenter_study_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCIMAGING.110.961011?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -