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Layoun H, Mentias A, Kanaan C, Badwan O, Matta M, Kassab J, Gillinov MA, Hodges K, Griffin BP, Kapadia SR, Harb SC. Differences in patterns of progression of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2023; 24:223-231. [PMID: 36256596 DOI: 10.1093/ehjci/jeac200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS Little data exist about the natural history and disease progression of secondary mitral regurgitation (SMR). We sought to study the temporal progression of left-sided volumes and functions in patients who progress to develop severe SMR. METHODS AND RESULTS We screened patients with chronic severe SMR who had at least one previous transthoracic echocardiography showing non-severe MR. Unsupervised phenotypic clustering based on baseline and rate of change in left ventricular (LV) and left atrial (LA) volumes, ejection fraction (EF), and MR severity progression identified two different phenotypes. We then compared them in terms of clinical characteristics, mechanistic and anatomical features, management, and outcomes. A total of 257 patients were included. Cluster 1 started with lower EF and LA strain and higher LV and LA volumes compared with Cluster 2, with a slower progression into severe SMR. At the onset of severe MR, Cluster 2 still had higher EF, lower LV volumes, but similar LA volumes and strain, and less proportionate SMR, compared with Cluster 1. They also had higher tenting height and more compensatory leaflet growth. On follow-up, Cluster 1 had more ventricular-directed therapies, whereas Cluster 2 received more mitral valve interventions. While the heart failure burden was higher in Cluster 1, there was no difference in mortality rates. CONCLUSION Based on disease progression, two distinct progression patterns of SMR exist, having different anatomical and mechanistic features with variation in management and outcomes.
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Affiliation(s)
- Habib Layoun
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Amgad Mentias
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Christopher Kanaan
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Osamah Badwan
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Milad Matta
- Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Joseph Kassab
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Marc A Gillinov
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Kevin Hodges
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Brian P Griffin
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Samir R Kapadia
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
| | - Serge C Harb
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44118, USA
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Boudoulas KD, Pitsis AA, Theofilogiannakos EK, Madiai F, Koenig S, Kelpis TG, Mohler PJ, Mazzaferri EL, Boudoulas H. Floppy Mitral Valve/Mitral Valve Prolapse (FMV/MVP): An unrevealed genotype - Phenotype relationship. Hellenic J Cardiol 2020; 61:354-356. [PMID: 31945479 DOI: 10.1016/j.hjc.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
| | | | | | - Francesca Madiai
- Davis Heart and Lung Research Institute, The Ohio State University, USA
| | - Sara Koenig
- Davis Heart and Lung Research Institute, The Ohio State University, USA
| | | | - Peter J Mohler
- Davis Heart and Lung Research Institute, The Ohio State University, USA
| | - Ernest L Mazzaferri
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Harisios Boudoulas
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA; Biomedical Research Foundation, Academy of Athens, Athens, Greece
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