Sudden death in mitral regurgitation due to flail leaflet

被引:213
作者
Grigioni, F
Enriquez-Sarano, M
Ling, LH
Bailey, KR
Seward, JB
Tajik, AJ
Frye, RL
机构
[1] Mayo Clin & Mayo Fdn, Div Cardiovasc Dis & Internal Med, Rochester, MN 55905 USA
[2] Mayo Clin & Mayo Fdn, Biostat Sect, Rochester, MN 55905 USA
关键词
D O I
10.1016/S0735-1097(99)00474-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We sought to assess the incidence and determinants of sudden death (SUD) in mitral regurgitation due to flail leaflet (MR-FL). BACKGROUND Sudden death is a catastrophic complication of MR-FL. Its incidence and predictability are undefined. METHODS The occurrence of SUD was analyzed in 348 patients (age 67 +/- 12 years) with MR-FL diagnosed echocardiographically from 1980 through 1994. RESULTS During a mean follow-up of 48 +/- 41 months, 99 deaths occurred under medical treatment. Sudden death occurred in 25 patients, three of whom were resuscitated. The sudden death rates at five and 10 years were 8.6 +/- 2% and 18.8 +/- 4%, respectively, and the linearized rate was 1.8% per year. By multivariate analysis, the independent baseline predictors of SUD were New York Heart Association (NYHA) functional class (p = 0.006), ejection fraction (p = 0.0001) and atrial fibrillation (p = 0.059). The yearly linearized rate of sudden death was 1% in patients in functional class I, 3.1% in class II and 7.8% in classes III and IV. However, of 25 patients who had SUD, at baseline, 10 (40%) were in functional class I, 9 (36%) were in class II and only 6 (24%) in class III or IV. In five patients (20%), no evidence of risk factors developed until SUD. In patients with an ejection fraction greater than or equal to 60% and sinus rhythm, the Linearized rate of SUD was not different in functional classes I and II (0.8% per year). Surgical correction of MR (n = 186) was independently associated with a reduced incidence of SUD (adjusted hazard ratio [95% confidence interval] 0.29 [0.11 to 0.72], p = 0.007). CONCLUSIONS Sudden death is relatively common in patients with MR-FL who are conservatively managed. Patients with severe symptoms, atrial fibrillation and reduced systolic function are at higher risk, but notable rates of SUD have been observed without these risk factors. Correction of MR appears to be associated with a reduced incidence of SUD, warranting early consideration of surgical repair. (C) 1999 by the American College of Cardiology.
引用
收藏
页码:2078 / 2085
页数:8
相关论文
共 59 条
  • [51] PULSED DOPPLER ECHOCARDIOGRAPHIC DETECTION OF MITRAL REGURGITATION IN MITRAL-VALVE PROLAPSE - CORRELATION WITH CARDIAC-ARRHYTHMIAS
    SHAH, AA
    QUINONES, MA
    WAGGONER, AD
    BARNDT, R
    MILLER, RR
    [J]. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS, 1982, 8 (05): : 437 - 444
  • [52] Shah P M, 1994, J Am Soc Echocardiogr, V7, P286
  • [53] PROGNOSTIC VALUE AND PHYSIOLOGICAL CORRELATES OF HEART-RATE-VARIABILITY IN CHRONIC SEVERE MITRAL REGURGITATION
    STEIN, KM
    BORER, JS
    HOCHREITER, C
    OKIN, PM
    HERROLD, EM
    DEVEREUX, RB
    KLIGFIELD, P
    [J]. CIRCULATION, 1993, 88 (01) : 127 - 135
  • [54] MITRAL-VALVE PROLAPSE - REVIEW OF ASSOCIATED ARRHYTHMIAS
    SWARTZ, MH
    TEICHHOLZ, LE
    DONOSO, E
    [J]. AMERICAN JOURNAL OF MEDICINE, 1977, 62 (03) : 377 - 389
  • [55] Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation - Rationale for optimizing surgical indications
    Tribouilloy, CM
    Enriquez-Sarano, M
    Schaff, HV
    Orszulak, TA
    Bailey, KR
    Tajik, AJ
    Frye, RL
    [J]. CIRCULATION, 1999, 99 (03) : 400 - 405
  • [56] EFFECTS OF CHRONIC BETA-ADRENERGIC-BLOCKADE ON THE LEFT-VENTRICULAR AND CARDIOCYTE ABNORMALITIES OF CHRONIC CANINE MITRAL REGURGITATION
    TSUTSUI, H
    SPINALE, FG
    NAGATSU, M
    SCHMID, PG
    ISHIHARA, K
    DEFREYTE, G
    COOPER, G
    CARABELLO, BA
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1994, 93 (06) : 2639 - 2648
  • [57] MITRAL-VALVE PROLAPSE SYNDROME AND RECURRENT VENTRICULAR TACHYARRHYTHMIAS
    WEI, JY
    BULKLEY, BH
    SCHAEFFER, AH
    GREENE, HL
    REID, PR
    [J]. ANNALS OF INTERNAL MEDICINE, 1978, 89 (01) : 6 - 9
  • [58] THE NATURAL HISTORY OF RHEUMATIC HEART DISEASE IN THE 3RD, 4TH, AND 5TH DECADES OF LIFE .1. PROGNOSIS WITH SPECIAL REFERENCE TO SURVIVORSHIP
    WILSON, MG
    LIM, WN
    [J]. CIRCULATION, 1957, 16 (05) : 700 - 712
  • [59] LIFE-THREATENING ARRHYTHMIAS IN MITRAL-VALVE PROLAPSE SYNDROME
    WINKLE, RA
    LOPES, MG
    POPP, RL
    HANCOCK, EW
    [J]. AMERICAN JOURNAL OF MEDICINE, 1976, 60 (07) : 961 - 967