TABLE 1.
Population Characteristics
| Mitral Regurgitation Severity | |||||
|---|---|---|---|---|---|
| Overall (N = 8,631) |
Absent (n = 6,272) |
Mild (n = 1,992) |
Advanced* (n = 372) |
p Value | |
| Clinical | |||||
| Age. yrs | 60.0 ± 14.1 | 58.7 ± 14.1 | 63.4 ± 13.4 | 64.5 ± 14.1 | <0.001 |
| Sex | 0.061 | ||||
| Male | 55 (4,765) | 55 (3,461) | 56 (1,118) | 50 (186) | |
| Female | 45 (3,866) | 45 (2,806) | 44 (874) | 50 (186) | |
| Body surface area. m2† | 1.81 ± 0.23 | 1.82 ± 0.23 | 1.80 ± 0.23 | 1.75 ± 0.24 | <0.001 |
| Pharmacological stress protocol | <0.001 | ||||
| Adenosine | 71 (6,034) | 70 (4,320) | 72 (1,416) | 80 (298) | |
| Regadenoson | 29 (2,498) | 30 (1,872) | 28 (553) | 20 (73) | |
| Atherosclerosis risk factors | |||||
| Hypertension | 68 (5,830) | 65 (4,099) | 72 (1,440) | 78 (291) | <0.001 |
| Hypercholesterolemia | 56 (4,841) | 55 (3,436) | 59 (1,181) | 60 (224) | 0.032 |
| Diabetes mellitus | 28 (2,399) | 27 (1,674) | 31 (609) | 31 (116) | 0.053 |
| Current or prior tobacco use | 32 (2,719) | 31 (1,955) | 33 (652) | 30 (112) | 0.662 |
| Family history of coronary artery disease | 31 (2,650) | 31 (1,940) | 30 (604) | 29 (106) | 0.326 |
| Known coronary artery disease | 30 (2,583) | 28 (1,743) | 35 (701) | 37 (139) | <0.001 |
| Myocardial infarction | 19 (1,642) | 17 (1,083) | 23 (457) | 28 (104) | <0.001 |
| Percutaneous coronary intervention | 7 (579) | 7 (429) | 7 (134) | 4 (16) | 0.062 |
| Coronary artery bypass graft | 2 (200) | 2 (140) | 3 (49) | 3 (11) | 0.364 |
| Clinical heart failure | 18 (1,515) | 13 (801) | 26 (513) | 54 (201) | <0.001 |
| Symptoms | |||||
| Chest pain | 48 (4,166) | 51 (3,174) | 42 (844) | 40 (148) | <0.001 |
| Dyspnea | 28 (2,458) | 27 (1,674) | 32 (635) | 40 (149) | <0.001 |
| Palpitations | 8 (672) | 8 (525) | 7 (131) | 4 (16) | 0.007 |
| Cardiovascular medications | |||||
| Aspirin | 57 (4,907) | 55 (3,472) | 60 (1,200) | 63 (235) | 0.001 |
| HMG-CoA reductase inhibitor | 50 (4,283) | 48 (3,008) | 54 (1,072) | 55 (203) | 0.009 |
| Beta-blocker | 36 (3,097) | 33 (2,055) | 43 (856) | 50 (186) | <0.001 |
| ACE inhibitor/ARB | 47 (4,040) | 45 (2,795) | 52 (1,026) | 59 (219) | <0.001 |
| Aldosterone antagonist | 5 (414) | 3 (212) | 8 (150) | 14 (52) | <0.001 |
| Loop diuretic | 31 (2,689) | 28 (1,753) | 37 (729) | 56 (207) | <0.001 |
| CMR | |||||
| Left ventricular function/geometry* | |||||
| End-diastolic volume, ml/m2 | 83.2 ± 30.9 | 78.1 ± 24.9 | 90.9 ± 34.5 | 130.9 ± 49.0 | <0.001 |
| End-systolic volume, ml/m2 | 39.6 ± 28.5 | 34.3 ± 20.9 | 47.6 ± 33.7 | 88.4 ± 48.7 | <0.001 |
| Ejection fraction, % | 55.6 ± 14.1 | 57.9 ± 12.0 | 51.9 ± 16.3 | 36.7 ± 16.4 | <0.001 |
Values are mean ± SD or % (n). unless otherwise indicated.
Advanced functional mitral regurgitation was first identified by using established semi-quantitative criteria (17) and then confirmed quantitatively based on differential aortic forward flow (phase contrast - cardiac magnetic resonance [CMR]) to left ventricular stroke volume (cine-CMR): 26.6% (n = 99). differential right ventricular/left ventricular stroke volume (cine-CMR): 50.8% (n = 189), and/or anatomic regurgitant office area (cine-CMR): 22.6% (n = 84).
Body surface area unavailable for 2.5% (n = 216). left ventricular volume unavailable for 4% (n = 374 [not quantifiable due to technical artifact or arrhythmia]). The p values are for linear tests of trends. The p values bolded where p < 0.05.
ACE - angiotensin-converting enzyme; ARB - angiotensin receptor blocker; MMG-CoA - 3-hydroxy-3-methylglutaryl coenzyme A.