Clinical Study On Clinical Characteristics, Treatment Decisions And Prognosis Of Elderly Patients With Mitral Regurgitation In A Chinese Multicenter

[Objective]To analyze the characteristics,etiologies,treatment and prognosis of elderly patients with mitral regurgitation in China,so as to support data for the development of new MR treatment technology in the future.[Methods]From September to December 2016,2248 elderly patients with moderate or severe MR were prospectively registered in 72 hospitals in China.According to different treatment methods,they were divided into intervention group(332 cases)and drug therapy group(1916 cases).The baseline characteristics,treatment methods and prognosis of the two groups were compared.[Results]Compared with the intervention group,the patients in the drug therapy group were older[(70.74±7.23)y vs.(65.65±4.53)y],with higher rate of hypertension(61.33%vs.49.10%),diabetes(29.59%vs.12.65%),coronary heart disease(49.53%vs.16.27%),renal insufficiency(8.04%vs.3.61%),cerebrovascular disease(11.80%vs.7.53%),NYHA class IV(19.05%vs.5.32%),LVEF<60%(76.2%vs.39.46%),all P<0.05.Degenerative MR was most common in Chinese elderly patients(29.77%),followed by ischemic(25.23%)and functional MR(22.78%).The intervention group had a higher proportion of rheumatic and degenerative diseases(18.07%vs.3.55%,39.76%vs.28.03%,P<0.001),while the drug treatment group had a higher proportion of ischemic and functional diseases(18.07%vs.3.55%,39.76%vs.28.03%,P<0.001).In the intervention group,the in-hospital mortality was 3.61%,and the one-year cumulative survival rate was 96.2%,while in the drug treatment group,the in-hospital mortality was 9.2%,and the one-year cumulative survival rate was 88.7%.Multivariate logistic regression analysis showed that age,symptoms of cardiac insufficiency,NYHA class Ⅲ and Ⅳ,history of CABG,decreased LVEF,no intervention and no use of RAAS inhibitors were the risk factors for mortality.[Conclusion]In Chinese elderly patients with MR,the incidence of complications is high and the intervention rate is low.Degenerative MR is most common in the elderly in China.According to the characteristics of patients,drug therapy or intervention can reduce the mortality and improve the one-year cumulative survival rate of elderly patients with MR.[Objective]To investigate the incidence and treatment of atrial fibrillation in elderly patients with MR in China,and to analyze whether atrial fibrillation is related to MR treatment strategy and prognosis.[Methods]From September to December 2016,2248 elderly patients with moderate or severe MR were prospectively registered in 72 hospitals in China.According to combined atrial fibrillation,they were divided into AF group(537 cases)and non-AF group(1711 cases).[Results]The rate of Chinese elderly MR patients combined with atrial fibrillation was 23.89%(537/2248).Compared with the non-AF group,the patients in the AF group were older[(70.93±7.09)vs.(69.69±7.11)(P<0.001)],with higher rate of smoking(72.5%vs.67.97%),cardiomyopathy(14.71%vs.10.29%)and previous ischemic stroke(12.66%vs.7.95%)(all P<0.05).Patients in AF group were more likely to have symptoms of cardiac insufficiency(73.00%vs.67.62%),higher rates of NYHA class Ⅲ(45.55%vs.37.36%)and Ⅳ(19.49%vs.16.10%)than those in non-AF group(all P<0.05).There were more rheumatic and functional MR in AF group than that in non AF group(11.73%vs.3.80%,28.12%vs.21.10%,P<0.001).The rate of anticoagulant therapy in Chinese elderly MR patients with AF was 46.93%.There was no significant difference in intervention rate between AF group and non-AF group(16.95%vs.17.53%,P>0.05).There was no significant difference in length of hospitalization,ICU stay,in-hospital complications and mortality between AF group and non-AF group(all P>0.05).One year follow-up showed that there was no significant difference in one-year cumulative survival rate and rehospitalization rate due to heart failure between AF group and non AF group(89.7%vs.89.9%,4.84%vs.5.03%,P>0.05).Multivariate analysis showed that age,decreased LVEF and no intervention were the risk factors for 1-year rehospitalization of heart failure(P<0.05).Atrial fibrillation is not a risk factor for one-year rehospitalization and cumulative survival rate.[Conclusion]In Chinese elderly patients with MR,the incidence of combined atrial fibrillation is high.Compared with non-AF patients,AF patients have severe symptoms,higher rate of previous stroke.The presence of AF did not affect the strategy of MR intervention.Atrial fibrillation has no significant adverse effect on the short-term and mid-term prognosis of elderly MR patients.