Korean Circ J.  2024 Jun;54(6):311-322. 10.4070/kcj.2023.0292.

Mitral Annular Tissue Velocity Predicts Survival in Patients With Primary Mitral Regurgitation

• Choi YJ
• Park CS
• Rhee TM
• Lee HJ
• Choi HM
• Hwang IC
• Park JB
• Yoon YE
• Na JO
• Kim HK
• Kim YJ
• Cho GY
• Sohn DW
• Lee SP

• KMID: 2556528
• DOI: http://doi.org/10.4070/kcj.2023.0292

Abstract

Background and Objectives
Early diastolic mitral annular tissue (e’) velocity is a commonly used marker of left ventricular (LV) diastolic function. This study aimed to investigate the prognostic implications of e’ velocity in patients with mitral regurgitation (MR).
Methods
This retrospective cohort study included 1,536 consecutive patients aged <65 years with moderate or severe chronic primary MR diagnosed between 2009 and 2018. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. According to the current guidelines, the cut-off value of e’ velocity was defined as 7 cm/s.
Results
A total of 404 individuals were enrolled (median age, 51.0 years; 64.1% male; 47.8% severe MR). During a median 6.0-year follow-up, there were 40 all-cause mortality and 16 cardiovascular deaths. Multivariate analysis revealed a significant association between e’ velocity and all-cause death (adjusted hazard ratio [aHR], 0.770; 95% confidence interval [CI], 0.634–0.935; p=0.008) and cardiovascular death (aHR, 0.690; 95% CI, 0.477–0.998; p=0.049). Abnormal e’ velocity (≤7 cm/s) independently predicted all-cause death (aHR, 2.467; 95% CI, 1.170–5.200; p=0.018) and cardiovascular death (aHR, 5.021; 95% CI, 1.189–21.211; p=0.028), regardless of symptoms, LV dimension and ejection fraction. Subgroup analysis according to sex, MR severity, mitral valve replacement/repair, and symptoms, showed no significant interactions. Including e’ velocity in the 10-year risk score improved reclassification for mortality (net reclassification improvement [NRI], 0.154; 95% CI, 0.308– 0.910; p<0.001) and cardiovascular death (NRI, 1.018; 95% CI, 0.680–1.356; p<0.001).
Conclusions
In patients aged <65 years with primary MR, e’ velocity served as an independent predictor of all-cause and cardiovascular deaths.

Keyword

Mitral regurgitation; Echocardiography, Doppler; Heart failure, Diastolic; Prognosis

Figure

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  Figure 1 Kaplan–Meier survival curves for (A) all-cause and (B) cardiovascular mortality in patients with degenerative mitral regurgitation.e’ velocity = early diastolic mitral annular tissue velocity.

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  Figure 2 Subgroup analysis for all-cause death.CI = confidence interval; e’ velocity = early diastolic mitral annular tissue velocity; HR = hazard ratio; MR = mitral regurgitation; MV = mitral valve; NYHA Fc = New York Heart Association functional classification.

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