The MIDA Mortality Risk Score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation

Francesco Grigioni (1) , Marie-Annick Clavel (2) , Jean-Louis Vanoverschelde (3, 4, 5, 6) , Christophe Tribouilloy (7, 8) , Rodolfo Pizarro , Marianne Huebner , Jean-François Avierinos (9) , Andrea Barbieri (10) , Rakesh Suri , Agnes Pasquet (11, 12) , Dan Rusinaru (13, 14) , Gaetano D. Gargiulo , Pablo Oberti , Alexis Theron (15) , Francesca Bursi , Hector Michelena , Siham Lazam , Catherine Szymanski (7) , Vuyisile T. Nkomo , Martin Schumacher , Letizia Bacchi-Reggiani , Maurice Enriquez-Sarano (16) , Mida Investigators

1 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
2 Mayo Clinic [Rochester]
3 MIRO - Pôle d’Imagerie Médicale, Radiothérapie et Oncologie
4 CARD - Pôle de Recherche Cardiovasculaire
5 IREC - Institut de Recherche Expérimentale et Clinique
6 Division of Cardiology
7 CHU Amiens-Picardie
8 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
9 APHM - Assistance Publique - Hôpitaux de Marseille
10 IRPPS-CNR, Salerno
11 UCL - Université Catholique de Louvain = Catholic University of Louvain
12 Cliniques Universitaires Saint-Luc [Bruxelles]
13 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
14 Service de Cardiologie [Amiens]
15 AMU - Aix Marseille Université
16 Mayo Clinic [Rochester, MN, USA]

Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 +/- 14 years; 70% males; follow-up 7.8 +/- 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 +/- 1, 57 +/- 4, and 21 +/- 10% under medical management and 99 +/- 1, 82 +/- 2, and 57 +/- 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P <= 0.002). Conclusion The MIDA Score may represent an innovative tool for DMR management, being able to position a given patient within a continuous spectrum of short-and long-term mortality risk, either under medical or surgical management. This innovative prognostic indicator may provide a specific framework for future clinical trials aiming to compare new technologies for DMR treatment in homogeneous risk categories of patients.

Domaines: Sciences du Vivant [q-bio]

Francesco Grigioni, Marie-Annick Clavel, Jean-Louis Vanoverschelde, Christophe Tribouilloy, Rodolfo Pizarro, et al.. The MIDA Mortality Risk Score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation. European Heart Journal, 2018, 39 (15), pp.1281-1291. ⟨10.1093/eurheartj/ehx465⟩. ⟨hal-03580340⟩