Others (Structural Heart Disease)
Analysis of Current Management and Prognosis of Elderly Hospitalized Patients with Primary Mitral Regurgitation from a Multicenter Study
Fuwai Hospital, China1
Valvular Heart Disease (VHD) is a common cardiovascular disease with a prevalence of moderate to severe valvular disease in the general population of approximately 2% to 2.5%. Foreign literature reports that the incidence of VHD increases with age, and the incidence of VHD is less than 2% in people under 75 years old, and 13.2% in people over 75 years old. Valvular heart disease is characterized by aortic stenosis and mitral regurgitation. China is currently entering an aging society. The elderly population is an average of 5.96 million per year. Chinese elderly mitral regurgitation Patients are also gradually increasing. The purpose of this study was to describe demographic characteristics, clinical features, stage stratification, diagnostic procedures, and treatment status of elderly hospitalized patients with mitral regurgitation, to analyze difference in treatment strategies of different stages under current guidelines and to identify factors associated with treatment decisions.
This study was a large-scale, multi-center and prospective study. The source of data in this study was from China Degenerative Valve Disease Cohort Study(China-DVD)database. Elderly hospitalized patients aging over 60 with a diagnosis of mitral regurgitation caused by primary etiology were enrolled consecutively as main subjects(N=2130). Baseline information, clinical records and follow-up data of all patients enrolled were searched and collected from China-DVD database. 2130 subjects were divided into several subgroups according to different age, stages, etiology types and recommendation classes for invasive treatment in guidelines in order to make further analysis and statistic process. In analysis of factors related to treatment decisions and analysis of factors related to short-medium-term survival, we use a multivariable logistic model and a multivariable Cox proportional-hazards model respectively. Probabilitiesp<0.05 were considered statistically significant. Short and medium term survival was analyzed and curved using the Kaplan–Meier method and Log-rank test.
A total number of 2130 elderly hospitalized patients with primary mitral regurgitation were enrolled in this study, with an age of 70.413±7.566 years. The most common etiology of elderly MR was degeneration(1398, 29.32%), and its prevalence in patients aged over 70 was 37.77%. Elderly patients with primary MR in this study combined with several comorbidities. Hypertension(1038, 48.73%) was the most common cardiovascular comorbidity and stroke(235, 11.03%) was the most common comorbidity of other systems. An impaired LVEF was showed in 1329 patients and pulmonary hypertension was found in 1044 patients. A total number of 725(34.04%) patients undergone invasive treatment of mitral valve and the most common invasive treatment was valve repair(427, 58.95%). Postoperative complications occurred in 69(9.52%) patients and 26(1.22%) patients died during hospitalization. In sub-group analysis, the rate of invasive treatment was significantly higher in degenerative MR subgroup than in rheumatic MR subgroup(23.75% vs. 55.26%, p<0.001). In stage B, C1, C2 and D subgroups, there were 131(18.58%) patients, 48(20.51%) patients, 5(26.32%) patients and 541(46.16%) patients who underwent invasive treatment respectively. The incidence of invasive treatment increased significantly with stage level elevated(p<0.001). In 60-69 years, 70-79 years and ≥80years subgroups there were 599(49.26%) patients,117(17.92%) patients and 9(3.45%) patients who underwent invasive treatment respectively. In multivariable logistic model, age(p<0.001,OR=2.478), LVEF(p=0.010,OR=0.531) and combing at least one comorbidity(p=0.002, OR=1.970) were factors related to treatment decisions in (stage D+ stage C2) subgroup. and age(p<0.001,OR=3.062) was also the factor related to treatment decision in (stageC1) subgroup.
This study provided a report on the current status and prognosis of primary MR on a large-scale elderly-based population. Conclusions from this multicenter study were as follows: 1. The most common etiology of elderly MR was degenerative origin, and the prevalence of degenerative MR was higher in older patients more than 75 years.2. A large proportion of elderly hospitalized patients with primary MR had a complex clinical situation with several comorbidities, an impaired LVEF and a later stage.3. Compared to patients with rheumatic etiology or younger age, the rate of invasive treatment was lower in patients with a degenerative etiology and an older age. 4. As to MR of stage D and C2 which was recommended for invasive treatment, the rate of invasive treatment was far from ideal and factors related to invasive treatment denial included age, LVEF and combing at least one comorbidity.