MO61. Interpapillary Muscle Distance Predicts Recurrent Mitral Regurgitation Independently from End-Diastolic Left Ventricle Diameter. 5-Years Echocardiographic Results from the PMA Trial
Presented During: Mini-Orals: Translational Research, Innovation, Predictive Modeling
Weill Cornell Medical Center
New York, NY
United States - Contact Me
Dr. Ivancarmine Gambardella is a cardiothoracic and vascular surgeon. He has an interest in surgical pathology of the aorta with a focus end-organ protection and neuro-metabolism; surgical pathology of the mitral valve with a focus on ischemic etiology and subvalvular remodelling; advanced statistical elaborations with a focus on risk-adjustment and prediction models. His scientific contributions have been presented at conferences of major cardiothoracic and vascular societies, and published in their respective journals. He has been an assistant professor of cardiothoracic surgery at Weill Cornell Medicine since 2018.
Friday, May 5, 2023: 7:25 AM - 7:30 AM
5 Minutes
New York Hilton Midtown
Room: Petit Trianon
Description
Objective: Recurrent ischemic mitral regurgitation (IMR) is caused by displacement of papillary muscles due to progressive increase of the left ventricle end-diastolic diameter (LVEDD). We aimed at demonstrate that, if interpapillary muscle distance (IPD) is surgically stabilized, the increase of LVEDD is not associated to recurrent IMR.
Methods: Ninety-six patient with severe IMR were randomized 1:1 for reduction annuloplasty (RA) vs RA + papillary muscle approximation (PMA). At 5 years follow-up, we evaluated: [1] the association of echocardiographic predictors to recurrent IMR (i.e., moderate-severe MR ± reoperation); [2] the correlation of PMA with an improvement of echocardiographic parameters during the study period (i.e., their Δ between preoperative and 5-year measurements); [3] the quantification of how many standard deviations (SD) PMA reduced adverse outcomes.
Results: IPD was the only independent predictor of recurrent moderate to severe MR (OR 10.55, 95% CI 0.61 | 1.33), when adjusted for α and β angles, tenting area, and LVEDD. PMA correlated to an amelioration of α (ρ -0.85) and β (ρ -0.87) angles, pulmonary systolic arterial pressure (ρ -0.44), recurrent MR (ρ -0.32), tenting area (ρ -0.76), left ventricular ejection fraction (ρ +0.56) and end-systolic diameter (ρ -0.67) (p <0.01 for all). PMA reduced the recurrence of MR of 1.91 SD (95% CI -2.28|-1.54), re-hospitalization for heart failure of 2.61 SD (95% CI -2.99|-2.22), reoperation of 2.64 SD (95% CI -3.04|-2.60) cardiac mortality of 2.9 SD (95% CI -3.30|-2.49), and overall mortality of 3.34 SD (95% CI –3.78|-2.90). The results are further detailed in the Figure.
Conclusions: At 5-years follow-up, recurrent IMR is independently predicted by IPD and not by LVEDD. If IPD is surgically stabilized, progressive LVEDD enlargement does not associate with recurrent IMR.
Methods: Ninety-six patient with severe IMR were randomized 1:1 for reduction annuloplasty (RA) vs RA + papillary muscle approximation (PMA). At 5 years follow-up, we evaluated: [1] the association of echocardiographic predictors to recurrent IMR (i.e., moderate-severe MR ± reoperation); [2] the correlation of PMA with an improvement of echocardiographic parameters during the study period (i.e., their Δ between preoperative and 5-year measurements); [3] the quantification of how many standard deviations (SD) PMA reduced adverse outcomes.
Results: IPD was the only independent predictor of recurrent moderate to severe MR (OR 10.55, 95% CI 0.61 | 1.33), when adjusted for α and β angles, tenting area, and LVEDD. PMA correlated to an amelioration of α (ρ -0.85) and β (ρ -0.87) angles, pulmonary systolic arterial pressure (ρ -0.44), recurrent MR (ρ -0.32), tenting area (ρ -0.76), left ventricular ejection fraction (ρ +0.56) and end-systolic diameter (ρ -0.67) (p <0.01 for all). PMA reduced the recurrence of MR of 1.91 SD (95% CI -2.28|-1.54), re-hospitalization for heart failure of 2.61 SD (95% CI -2.99|-2.22), reoperation of 2.64 SD (95% CI -3.04|-2.60) cardiac mortality of 2.9 SD (95% CI -3.30|-2.49), and overall mortality of 3.34 SD (95% CI –3.78|-2.90). The results are further detailed in the Figure.
Conclusions: At 5-years follow-up, recurrent IMR is independently predicted by IPD and not by LVEDD. If IPD is surgically stabilized, progressive LVEDD enlargement does not associate with recurrent IMR.
Presentation Duration
3-minute presentation; 2-minute discussion