Rahul Sharma, MBBS, FRACP
Director of Structural Interventions, Stanford Healthcare, Associate Director of the Cardiac Catheterization Laboratory and Clinical Associate Professor of Medicine, Stanford University and lead author of the study.
BACKGROUND
- Guidelines for management of mitral regurgitation (MR) recommend grading the severity of disease using echocardiographic criteria1,2
- Current guidelines specify that for select patients with severe MR, procedural (surgical or transcatheter) intervention is recommended1
- Contemporary data on rates of procedural intervention and corresponding untreated mortality for patients across all degrees of MR severity are lacking
METHODS
- De-identified real-world dataset (January 2018 to May 2023) of 1,177,381 patients from 25 US institutions participating in the egnite Database (egnite, Inc., Aliso Viejo, CA, USA) with appropriate permissions
- Given the dynamic nature of MR (particularly secondary/functional MR), the dataset treated MR as a time-varying covariate, with index event for study entry being first MR diagnosis
- Key outcomes: 2-year rates of treatment with mitral valve (MV) intervention and mortality without intervention were assessed using Kaplan-Meier estimates (results compared via log-rank test)
- Associations between individual covariates of interest and mortality without intervention were also assessed in a Cox model with all covariates treated as time-varying
RESULTS
- Of the 1,177,381 patients total, 936,993 patients had documented MR diagnosis with specified severity and were included in the main study analyses
- Median (interquartile range) time from index to death, MV intervention, or last documented clinical encounter was 448 (120-887) days
- Rates of intervention at 2 years were relatively low for patients with moderate-to-severe or severe MR
- At 2 years, estimated intervention rates (95% confidence interval [CI]) were:
- 13.5% (12.6%-14.5%) for moderate-to-severe MR
- 46.4% (44.9%-47.9%) for severe MR
- Mortality without MV intervention increased with greater MR severity
- At 2 years, estimated mortality rates (95% CI) were:
- 30.2% (29.0%-31.4%) for moderate-to-severe MR
- 31.8% (30.3%-33.4%) for severe MR
- Greater MR severity was independently associated with greater untreated mortality
CONCLUSIONS
- Despite untreated MR being associated with increased mortality, intervention rates for these patients remain relatively low
- Untreated mortality increased incrementally with greater MR severity and the presence of symptoms
- Further study is needed to assess optimal timing of procedural intervention for these patients
References
1. Otto CM, et al. JACC. 2021;77:e25-e197.
2. Zoghbi WA, et al. JASE. 2017;30(4):303-371.
*Specifically primary degenerative, per egnite mechanism of MR natural language processing-based algorithm.
Sharma RP, Cubeddu RJ, Généreux P, Eberst K, Rodriguez E, Gillam LD. Contemporary practice patterns and outcomes for patients with mitral regurgitation: Results from a large multicenter real-world database. Moderated abstract presentation at: Transcatheter Cardiovascular Therapeutics 2023; October 23-26, 2023; San Francisco, CA.
