Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

Table 1 Characteristics of aortic stenosis patients with different grades of mitral regurgitation

	0 or 1+ MR	2+ MR	3 or 4+ MR	P value
Age (yr)	70 ± 12	74 ± 9	72 ± 13	< 0.05
Women (%)	44	48	51	0.4
Syncope (%)	3	4	4	0.85
Angina (%)	38	49	47	0.12
Dyspnea (%)	39	38	62	0.002
Atrial fibrillation (%)	24	32	33	0.18
Hypertension (%)	58	57	44	0.06
Diabetes mellitus (%)	24	22	18	0.4
Coronary artery disease (%)	53	60	58	0.3
Renal insufficiency (%)	10	8	13	0.39
LV end-diastolic diameter (mm)	48 ± 7	48 ± 4	56 +10	< 0.0001
LV end-diastolic dimeter index (mm/m2)	26 ± 4	27 ± 4	23 + 6	< 0.0001
Left ventricular end-systolic diameter (mm)	31 ± 9	33 ± 9	41 + 13	< 0.0001
LV end-systolic dimeter index (mm/m2)	16 ± 4	18 ± 4	41 + 13	< 0.0001
Ventricular septum (mm)	14 ± 2	14 ± 3	14 + 3	0.2
Posterior wall (mm)	13 ± 2	13 ± 2	12 ± 2	0.13
Relative wall thickness	0.57 + 0.15	0.57 + 0.13	0.48 + 0.13	0.0006
LV ejection fraction (%)	62 ± 16	54 ± 17	45 ± 21	< 0.0001
Left atrial dimension (mm)	41 ± 9	43 ± 8	48 ± 6	< 0.0001
Aortic valve area (cm2)	0.72 + 0.16	0.68 + 0.16	0.70 + 0.20	0.18
Aortic valve peak gradient (mmHg)	73 ± 23	71 ± 26	67 +22	0.09
Aortic valve mean gradient (mmHg)	45 ± 15	43 ± 17	41 +15	0.08
Aortic regurgitation grade	0.65+0.83	1.16+0.91	1.00+1.00	< 0.0001
Mitral E/A velocity ratio	1.00 + 0.53	1.09 + 0.64	1.60 + 0.67	< 0.0001
Mitral E wave deceleration time (ms)	270 ± 105	278 ± 112	194 +89	0.0001
Pulmonary artery systolic pressure (mmHg)	40 ± 13	45 ± 20	53 +14	< 0.0001
Beta-blocker use (%)	46	46	27	0.02
ACEI or ARB use (%)	25	33	36	0.12
Digoxin use (%)	35	32	38	0.47
Statin use (%)	31	21	35	0.09
Coronary artery bypass grafting (%)	38	49	47	0.12
Mitral valve repair (%)	3	2	20	< 0.0001
Mitral valve replacement (%)	2	10	13	0.06

AS: Aortic stenosis; MR: Mitral regurgitation; LV: Left ventricular; ACEI: Angiotensin converting enzyme inhibitor; ARB: Angiotensin receptor blocker.

Table 2 Results of Cox regression analysis on the effect of mitral regurgitation on survival

Variable	χ2 value	P value
LV end-diastolic dimension	10.4	< 0.01
LV ejection fraction	23.3	< 0.0001
Mitral regurgitation	7.9	< 0.01

Global χ² = 34.3; LV: Left ventricular.