[Juntendo Educational Corporation] Clinical outcomes of mitral valve surgery for atrial functional mitral regurgitation disease
*Juntendo Educational Corporation*
Press release: August 16, 2024
**
Clinical outcomes of mitral valve surgery for atrial functional mitral regurgitation
*― REVEAL-AFMR multicenter joint research study -*
Specially Appointed Associate Professor Nobuyuki Kagiyama, Assistant Professor Tomohiro Kaneko, Professor Toru Minamino, Department of Internal Medicine, Department of Cardiovascular Medicine, Juntendo University School of Medicine, Minoru Tabata, Department of
Cardiovascular Surgery, Graduate School of Medicine.
The professor’s research group conducted joint research with 26 institutions in Japan on the actual state of atrial functional mitral regurgitation (*1). Mitral regurgitation (*2) is one of the most common causes of surgery among cardiac valvular diseases that have received attention in recent years, and among these, atrial functional mitral regurgitation is a newly discovered type. is.
This disease is attracting attention because it is common in the elderly and is associated with arrhythmia called atrial fibrillation (*3), which has been increasing in recent years.However, it is unclear how many patients there are and what treatments are effective. It was not clear whether that was the case. The present study found that the frequency of atrial functional mitral regurgitation was higher than expected, accounting for 11.4% (1 in 9 patients) of patients with mitral regurgitation, and that it It was found that the rate of death and hospitalization due to heart failure was low.
In atrial functional mitral regurgitation, there is no problem with the mitral valve itself, but as the atrium becomes extremely large, the mitral valve does not fit together properly, causing blood to flow backwards, leading to heart failure. The frequency and effectiveness of surgical treatment have not been clarified. This result, obtained by collecting data on treatment content and subsequent progress at many facilities, will serve as the basis for decision-making when considering treatment strategies. This paper is published by JAMA Published in the online edition of Network Open magazine on August 15, 2024.
* Key points of this research result *
● Conducted a large-scale study on atrial functional mitral regurgitation. ● The average age of patients with atrial functional mitral
regurgitation was 78 years old, and the incidence was 11.4% of patients with mitral regurgitation.
● Patients who underwent mitral valve surgery were found to be less likely to die or be hospitalized for heart failure.
*Background*
The mitral valve is located between the left atrium and left ventricle of the heart, and by opening and closing with the movement of the heart, its role is to prevent blood from flowing backwards within the heart. Mitral regurgitation occurs when the mitral valve does not close completely, causing blood to flow backwards, leading to heart failure. Functional mitral regurgitation is a disease in which there is no problem with the mitral valve itself, but problems occur in the ventricles and atria that support the valve, making it impossible for the mitral valve to close and causing regurgitation.
In recent years, a disease called atrial functional mitral
regurgitation has become known, in which the atrium becomes extremely large due to prolonged arrhythmia, which causes the mitral valve to malfunction, causing regurgitation. This is a relatively new concept, no major epidemiological studies have been conducted, and not much is known about the characteristics of this disease or how to treat it. This study was a collaborative study (REVEAL-AFMR study) (*4) conducted by 26 institutions in Japan, with the aim of clarifying the characteristics and treatment results of atrial functional mitral regurgitation.
* Contents *
In this study, we enrolled patients with moderate or severe atrial functional mitral regurgitation from all cardiac ultrasound
examinations performed in 2019 at 26 facilities in Japan. Of the 177,235 people who underwent cardiac ultrasound, 8,867 (5%) had moderate or severe mitral regurgitation, and 1,007 (11.4% of moderate or severe mitral regurgitation) had atrial I was diagnosed with functional mitral regurgitation. Among them, 113 patients underwent mitral valve surgery (surgery group), and the surgery group (mean age 74 years) was younger than the patients who continued drug treatment (mean age 78 years), and the degree of regurgitation (58.0%) (9.4% vs. 9.4%) and patients with severe heart failure symptoms (26.5% vs. 9.3%). Despite having more severe disease, the surgery group had better rates of death and heart failure hospitalization during the 3-year follow-up (18.3% vs. 33.3%).
Figure 1: Characteristics and outcomes of atrial functional mitral regurgitation
(Prognosis survey graph…vertical axis: incidence of death or heart failure, horizontal axis: time (days), green line: surgery group, red line: drug treatment group)
The REVEAL-AFMR study, a collaboration between 26 institutions in Japan, investigated 1,007 cases of atrial functional mitral
regurgitation. They accounted for 11.4% of patients with mitral regurgitation, and the average age was 78 years, with 78.9% having atrial fibrillation and 26.9% having heart failure. Patients who underwent mitral valve surgery had lower rates of death and
hospitalization for heart failure, and patients who underwent mitral valve surgery had fewer mitral regurgitation, fewer heart failure symptoms, and fewer adverse events.
*Future developments*
In this study, we revealed the actual prevalence and characteristics of atrial functional mitral regurgitation along with surgical outcomes. However, since the present results were an observational study, we cannot deny the possibility that patients undergoing surgery were in better condition to begin with. Future intervention trials are being considered to determine whether surgery improves patient outcomes in terms of causality.
*Glossary*
*1
Atrial functional mitral regurgitation: In mitral regurgitation, the left atrium has enlarged so much that the mitral valve can no longer reach and close properly. It is a relatively new disease concept whose mechanism has only been understood over the past 10 years.
*2
Mitral regurgitation: The mitral valve is a valve between the left ventricle and left atrium that prevents blood from flowing backwards from the left ventricle to the left atrium. Mitral regurgitation is a condition in which the mitral valve does not close properly and blood flows backwards due to some reason. It is also called mitral regurgitation.
*3 Atrial fibrillation: An arrhythmia that occurs in the atria, and is the main cause of atrial functional mitral regurgitation, and can also be a trigger for heart failure.
*4 REVEAL-AFMR study: REal-world observerVational study for invEstigAting the prevaLence and therapeutic options for Atrial Functional Mitral A retrospective multi-center collaborative study called Regurgitation consisting of 26 facilities nationwide. Among the patients who underwent echocardiography at 26 facilities in 2019, we investigated how many patients had atrial functional mitral regurgitation, and what characteristics and outcomes they showed.
*Original paper*
This study was published in the online version of JAMA Network Open on August 15, 2024.
Title: Clinical outcomes of mitral valve surgery in atrial functional mitral regurgitation: the REVEAL-AFMR registry
Title (Japanese translation): Clinical outcomes of mitral valve surgery for atrial functional mitral regurgitation: A review by REVEAL-AFMR multicenter collaborative study
Author: Nobuyuki Kagiyama; Tomohiro Kaneko; Masashi Amano; Yukio Sato; Yohei Ohno; Masaru Obokata; Kimi Sato; Taiji Okada; Naoki Hoshino; Kentaro Yamashita; Yuko Katsuta; Yuki Izumi; Mitsuhiko Ota; Yasuhide Mochizuki; Kaoruko Sengoku; Shunsuke Sasaki; Fukuko Nagura; Nanaka Nomura; Ryo Nishikawa; Nahoko Kato; Takahiro Sakamoto; Noriko Eguchi; Maiko Senoo; Mariko Kitano; Yoichi Takaya; Yoshihito Saijo; Hidekazu Tanaka; Kotaro Nochioka; Nami Omori; Minoru Tabata; Tohru Minamino; Naoki Hirose; Kojiro Morita; Tomoko Machino-Ohtsuka; Victoria Delgado; Yukio Abe
Author (in Japanese): Nobuyuki Kagiyama1); Tomohiro Kaneko1); Masashi Amano2); Yohei Sato3); Yohei Ohno4); Masaru Obokata5); Nozomi Sato6); Daiji Okada7);
Naoki Hoshino8); Kentaro Yamashita9); Yuko Katsuta10); Yuki Izumi11); Mitsuhiko Ota12); Yasuhide Mochizuki13); Kaoruko Sengoku14); Shunsuke Sasaki15);
Fukuko Nagura16); Nanaka Nomura17); Ryo Nishikawa18); Nahoko Kato19); Takahiro Sakamoto20); Noriko Eguchi21); Maiko Seno22); Mariko Kitano23);
Yoichi Takatani24); Yoshihito Saijo25); Hidekazu Tanaka9); Kotaro Gooka10); Nami Omori2); Minoru Tabata26); Toru Minamino1); Naoki Hirose27);
Kojiro Morita28); Tomoko Machino6); Victoria Delgado29); Yukio Abe17) Author affiliation: 1) Department of Cardiovascular Medicine, Juntendo University 2) Department of Heart Failure, National Cerebral and Cardiovascular Center, Department of Heart Failure and Transplantation 3)
St. Marianna University School of Medicine, Department of
Cardiovascular Medicine 4) Tokai University Department of
Cardiovascular Medicine 5) Gunma University Cardiovascular Medicine 6) University of Tsukuba, Cardiovascular Medicine 7) Kobe City Medical Center Chuo Municipal Hospital, Cardiovascular Medicine 8) Fujita Health University Cardiovascular Medicine 9) Kobe University Department of Cardiovascular Medicine 10) Tohoku University Department of Cardiovascular Medicine 11) Sakakibara Memorial Hospital
Cardiovascular Medicine 12) Toranomon Hospital Cardiovascular Center Internal Medicine 13) Showa University Cardiovascular Medicine 14) Osaka University Cardiovascular Medicine 15) Teinekei Jinkai Hospital Circulation Department of Internal Medicine 16) Teikyo University Department of Cardiovascular Medicine 17) Osaka City General Medical Center
Center Cardiovascular Medicine 18)
Sapporo Medical University Hospital Department of Cardiology, Nephrology, and Metabolic Endocrinology 19) Department of
Cardiovascular Medicine, Tokyo Bay Urayasu Ichikawa Medical Center 20) Shimane University Department of Cardiovascular Medicine and Nephrology 21) Chiba University Department of Cardiovascular Medicine 22) Hirosaki University Department of Cardiology and Nephrology Course 23) Kitano Hospital Cardiovascular Medicine 24) Okayama University Ultrasound Diagnostic Center 25) Tokushima University Cardiovascular Medicine 26) Juntendo University Cardiovascular Surgery 27) Hiroshima University Graduate
School of Biomedical and Health Sciences 28) University of Tokyo Graduate School of Global Nursing Research Center 29)
Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
DOI: 10.1001/jamanetworkopen.2024.28032
This research was supported by JSPS KAKENHI Grant Number 22K20895 and the Uehara Memorial Life Science Foundation Research Grant, and was conducted in collaboration with multiple institutions. We would like to express our deepest gratitude to everyone who cooperated with this research.