■退行性二尖瓣反流（DMR）的临床结果和介入阈值是在欧洲和美国机构（EAI）的患者研究中开发的，但对亚洲机构（AsIs）的患者知之甚少。
■本研究旨在对比AsI患者与EAI患者的DMR表现/管理/结果。
■来自香港和新加坡的连ail传单导致的DMR患者（AsI队列，n=737）与具有相似资格标准的MIDA（二尖瓣返流国际数据库）注册的EAI患者（n=682）进行比较。
■AsI患者与EAI患者表现出相似的DMR病变/后果，但他们更年轻,症状较少（74%vs44%I类），更多的窦性心律（83％vs69％），和较低的EuroSCOREII（欧洲心脏手术风险评估系统II）（0.9±0.5vs1.4±1.5；所有P<0.0001）。影像学显示AsI患者的绝对左心房/心室尺寸较小，以更大的体表面积指数直径（所有P<0.01）来进行心脏扩张。手术/介入二尖瓣修复同样占优势(90%vs91%;P=0.47),早期修复同样有益(对于AsI患者，调整后的HR：0.28；95%CI：0.16-0.49；对于EAI患者，HR：0.32；95%CI：0.20-0.49；两者P<0.0001）。然而,在长期诊断后，AsI患者接受的干预较少（55％±2％vs77％±2％；P<0.0001），并且死亡率过高（校正后HR：1.60[95％CI：1.13-2.27]vsEAI患者；P=0.008）。倾向评分匹配（434对患者），平衡了所有的临床特征，证实在患有DMR的AsI患者中存在长期治疗不足和超额死亡率(P<0.0001)。
■与二尖瓣病变和DMR严重程度相似的EAI患者相比，由于与较小体型相关的较小心脏腔，成像可能低估了AsI患者的容量超负荷。AsI患者享有相似的二尖瓣修复优势和早期干预获益，但与EAI患者相比，接受更少的二尖瓣干预，并导致随后的超额死亡率。提示需要考虑影像学和文化特异性，以改善全球DMR结局。
UNASSIGNED: Clinical outcome and interventional thresholds for degenerative mitral regurgitation (DMR) were developed in studies of patients at European and American institutions (EAIs), but little is known about patients at Asian institutions (AsIs).
UNASSIGNED: This study sought to contrast DMR presentation/management/outcomes of AsI patients vs EAI patients.
UNASSIGNED: Patients with DMR due to flail leaflet from Hong Kong and Singapore (AsI cohort, n = 737) were compared with EAI patients (n = 682) enrolled in the MIDA (Mitral regurgitation International Database) registry with similar eligibility criteria.
UNASSIGNED: AsI patients presented similar DMR lesion/consequences vs EAI patients, but they were younger, with fewer symptoms (74% vs 44% Class I), more sinus rhythm (83% vs 69%), and lower EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) (0.9 ± 0.5 vs 1.4 ± 1.5; all P < 0.0001). Imaging showed smaller absolute left atrial/ventricular dimensions in AsI patients, belying cardiac dilatation with larger body surface area-indexed diameters (all P < 0.01). Surgical/interventional mitral repair was similarly predominant (90% vs 91%; P = 0.47), and early repair was similarly beneficial (for AsI patients, adjusted HR: 0.28; 95% CI: 0.16-0.49; for EAI patients, HR: 0.32; 95% CI: 0.20-0.49; both P < 0.0001). However, AsI patients underwent fewer interventions (55% ± 2% vs 77% ± 2% at 1 year; P < 0.0001) and incurred excess mortality (adjusted HR: 1.60 [95% CI: 1.13-2.27] vs EAI patients; P = 0.008) at long-term postdiagnosis. Propensity score matching (434 patient pairs), which balanced all clinical characteristics, confirmed that there was undertreatment and excess mortality in the long term in AsI patients with DMR (P < 0.0001).
UNASSIGNED: Imaging may underestimate volume overload in AsI patients due to smaller cardiac cavities related to smaller body size compared with EAI patients with similar mitral lesions and DMR severity. AsI patients enjoy similar mitral repair predominance and early intervention benefits but undergo fewer mitral interventions than EAI patients and incur subsequent excess mortality, suggesting the need to account for imaging and cultural specificity to improve DMR outcomes worldwide.
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