Abstract 15881: Progression of Significant Functional Mitral Regurgitation in Medically Managed High Surgical Risk Patients

Background: Functional mitral valve regurgitation (FMR) remains a clinical challenge in patients with high operative risk. Medical therapy alone in FMR is associated with poor outcomes but data regarding MR and left ventricular (LV) systolic function changes over time are limited.

Objective: Study the progression of MR severity and LV function in medically managed MR patients with high surgical risk who survived at least 6 months.

Methods: Between Jan 1st, 2000 and Aug 31st, 2010, we identified patients with medically managed moderate to severe MR that fulfilled the EVEREST II High Risk Registry (HRR) criteria. All patients were selected based on optimal propensity matching and were required to have a follow up echocardiogram >6 months from the index study. Demographic, clinical and echocardiographic data was compared between baseline and follow up. Paired measurements of global longitudinal strain (GLS) were obtained in a subset of patients with suitable image quality.

Results: 159 patients (mean age 73.5, female 45%) fulfilled the study criteria. 130 patients(81%) had moderate and severe MR. Median STS score was 8.9 (IQR: 5.2-14.8) and betablockers as well as ACEI/ARB was used by 71% and 73% respectively. During a median follow-up of 441 days (IQR: 272-780), MR decreased in severity in 82 patients (51.6%) and remained unchanged or worsened in 77 patients (49.4%) Among patients with moderate MR at baseline, improvement was seen in 62 (47.5%), worsening in 6 (5%), and unchanged severity in 62 (47.5%).Among patients with severe MR at baseline, improvement was seen in 17 (58.5%) and 12 (41.5%) remained unchanged. Median LVEF did not change from baseline to follow-up (45%; IQR: 30-55 vs. 45%, IQR: 30-55, p=0.51). Among 43 patients with evaluable paired GLS measurements, GLS did not significantly change over time (-11.8 to -12.6; p=0.36)

Conclusions: Despite the high mortality in medically managed MR patients, a substantial number of survivors improve their MR grade at follow-up.