Highlights
- •Significant mitral regurgitation has a high prevalence in octogenarian patients with severe symptomatic aortic stenosis.
- •Mitral regurgitation is independently associated with the decision to treat conservatively in this population.
- •Mitral regurgitation was a significant independent predictor of overall mortality at 12-month follow-up.
Abstract
Introduction
The coexistence of significant mitral regurgitation (MR) and severe aortic stenosis
is prevalent, has a prognostic impact and makes treatment in the elderly population
a complex issue. The aim of this study is to determine the prevalence of significant
MR among a population of octogenarians and its influence on treatment and prognosis.
Methods
We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática
del Octogenario), a prospective registry that consecutively included 928 patients
aged ≥80 years with severe symptomatic aortic stenosis.
Results
The prevalence of significant MR was 8.5% (79 patients) and independently associated
with the decision to treat conservatively (odds ratio = 2.28, 95% confidence interval:
1.31–3.95, p = 0.003). The group of patients with significant MR had higher overall
mortality at 12 months follow-up (51.9% vs 25%, p < 0.001), which remained on division
into subgroups based on the presence of comorbidities (Charlson<5: 49.2% vs 21.9%,
p < 0.001; and Charlson ≥5: 62.5% vs 41.7%, p = 0.07). Within the group of patients
in whom conservative treatment was performed, those with significant MR had higher
mortality at one year (62.7% vs 35%, p < 0.001). MR was a significant independent
predictor of overall mortality at 12-month follow-up (hazard ratio = 1.87, 95% confidence
interval: 1.09–3.18, p = 0.022).
Conclusions
Significant MR has a high prevalence and worsens the prognosis of octogenarian patients
with severe symptomatic aortic stenosis, especially in patients with conservative
treatment, independently of the existence of comorbidities.
Keywords
Abbreviations:
AS (Aortic stenosis), MR (Mitral regurgitation), AVR (aortic valve replacement surgery), TAVI (Transcatheter aortic valve implantation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 17, 2018
Accepted:
May 10,
2018
Received in revised form:
April 10,
2018
Received:
January 29,
2018
Footnotes
☆All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
