RT Journal Article
SR Electronic
T1 Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1675
OP 1680
DO 10.1136/hrt.2011.225789
VO 97
IS 20
A1 Rossi, Andrea
A1 Dini, Frank L
A1 Faggiano, Pompilio
A1 Agricola, Eustachio
A1 Cicoira, Mariantonietta
A1 Frattini, Silvia
A1 Simioniuc, Anca
A1 Gullace, Mariangela
A1 Ghio, Stefano
A1 Enriquez-Sarano, Maurice
A1 Temporelli, Pier Luigi
YR 2011
UL http://heart.bmj.com/content/97/20/1675.abstract
AB Background Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF), but its effect on outcome is still uncertain, mainly because in previous studies sample sizes were relatively small and semiquantitative methods for FMR grading were used.Objective To evaluate the prognostic value of FMR in patients with HF.Methods and results Patients with HF due to ischaemic and non-ischaemic dilated cardiomyopathy (DCM) were retrospectively recruited. The clinical end point was a composite of all-cause mortality and hospitalisation for worsening HF. FMR was quantitatively determined by measuring vena contracta (VC) or effective regurgitant orifice (ERO) or regurgitant volume (RV). Severe FMR was defined as ERO >0.2 cm2 or RV >30 ml or VC >0.4 cm. Restrictive mitral filling pattern (RMP) was defined as E-wave deceleration time <140 ms. The study population comprised 1256 patients (mean age 67±11; 78% male) with HF due to DCM: 27% had no FMR, 49% mild to moderate FMR and 24% severe FMR. There was a powerful association between severe FMR and prognosis (HR=2.0, 95% CI 1.5 to 2.6; p<0.0001) after adjustment of left ventricular ejection fraction and RMP. The independent association of severe FMR with prognosis was confirmed in patients with ischaemic DCM (HR=2.0, 95% CI 1.4 to 2.7; p<0.0001) and non-ischaemic DCM (HR=1.9, 95% CI 1.3 to 2.9; p=0.002).Conclusion In a large patient population it was shown that a quantitatively defined FMR was strongly associated with the outcome of patients with HF, independently of LV function.