Frailty, Aging, and Risk of Adverse Outcomes in Mitral Valve Prolapse (FAR-OUT-MVP Study)

项目摘要 二尖瓣脱垂（MVP）是一种常见的心脏瓣膜疾病，在美国的患病率约为2-3%。 一般人群，与二尖瓣或腱索组织过多相关，可能易发生 瓣叶对合不良和腱索断裂导致的二尖瓣返流（MR）。这种情况及其后遗症， 在超声心动图（TTE）和心脏磁共振图像（CMR）上检测到， 被认为与总体良性预后相关。最近的证据表明，一个子集的个人与 MVP具有心血管和非心血管发病率和死亡率的过度风险，包括 室性心律失常和心源性猝死。尽管已知MVP的风险， 识别需要进一步治疗的高风险子集，例如使用植入式除颤器或二尖瓣 瓣膜修复或置换。此外，将MVP的风险与伴随MR的风险分开 目前仍然具有挑战性。此外，虽然已经确定了风险的个体成像生物标志物， 当一起考虑时，这些因素中的哪一个独立地影响MVP风险仍然不清楚。而相关 临床风险因素包括衰老和虚弱，“脆弱性增加和维持能力降低的状态 在多种生理系统受损导致的应激事件后的体内平衡，”已经发现 影响其他心脏瓣膜疾病的预后风险，但年龄和虚弱是否会改变风险仍不清楚 关于不良后果的MVP。该提案利用了两个大型数据源的独特链接， 来自Beth Israel Deaconess Medical Center和所有付款人的TTE和CMR报告的结构化数据集 来自马萨诸塞州病例组合数据集（MACM）的全州索赔数据，以更好地评估MVP的风险 跨越年龄和脆弱的范围。在这项研究中，我们建议直接链接BIDMC TTE和CMR报告 MACM数据，以评估MVP是否与死亡率、心血管发病率 （心力衰竭、房颤、脑血管事件、心内膜炎的复合终点），需要二尖瓣 置换或修复，以及这种风险关系是否因年龄和虚弱以及手术状态而异 （接受二尖瓣置换或修复）。这样做，这项研究将提供更深入的了解 衰老和虚弱可能对MVP相关严重结局风险的作用，并建立一个 与结局数据相关的心脏成像信息的唯一注册表， 以期加深对MVP及其他心脏瓣膜病的认识。

PROJECT SUMMARY Mitral valve prolapse (MVP) is a common cardiac valvular disease, with a prevalence of roughly 2-3% in the general population, associated with excess mitral valve or chordal tissue may predispose to the development of mitral regurgitation (MR) from leaflet malcoaptation and chordal rupture. This condition and its sequelae, detected on echocardiograms (TTEs) and cardiac magnetic resonance images (CMRs), has been previously felt to be associated with an overall benign prognosis. Recent evidence suggest a subset of individuals with MVP have an excess risk of cardiovascular and non-cardiovascular morbidity and mortality, including ventricular arrhythmias and sudden cardiac death. Despite known risks of MVP, it remains challenging to identify high risk subsets in need of further treatments such as implantable defibrillator use or mitral valve repair or replacement. Furthermore, disaggregating the risk of MVP from that of concomitant MR remains challenging at present. Moreover, while individual imaging biomarkers of risk have been identified, which of these independently influence MVP risk when considered together remains unclear. While relevant clinical risk factors including aging and frailty, “a state of increased vulnerability and reduced ability to maintain homeostasis after a stressful event resulting from an impairment in multiple physiologic systems,” have found to influence outcome risk in other valvular heart diseases, it remains unclear if aging and frailty modify the risk of MVP on adverse outcomes. This proposal leverages the unique linkage of two large data sources, structured datasets of TTE and CMR reports from Beth Israel Deaconess Medical Center, and all-payer statewide claims data from the Massachusetts Case Mix Dataset (MACM) to better evaluate the risk of MVP across the spectrum of age and frailty. In this study, we propose to directly link BIDMC TTE and CMR reports to MACM data to evaluate whether MVP is associated with a risk of mortality, cardiovascular morbidity (composite of heart failure, atrial fibrillation, cerebrovascular event, endocarditis), and need for mitral valve replacement or repair, and whether this risk relationship varies by age and frailty as well as operative status (receipt of mitral valve replacement or repair). Doing so, this study will provide greater insight into the role that aging and frailty may have on the risk of serious outcomes associated with MVP and build a unique registry of cardiac imaging information linked to outcome data that could be leveraged in the future to deepen understanding of MVP as well as other valvular heart diseases.