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

项目总结

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.