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 cm 2 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 67611; 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 (HR¼2.0, 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 (HR¼2.0, 95% CI 1.4 to 2.7; p<0.0001) and nonischaemic DCM (HR¼1.9, 95% CI 1.3 to 2.9; p¼0.002). 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.

AimsThe prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR. Methods and resultsWe enrolled 373 consecutive patients (mean age 68 + 11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1-120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36 + 2% and 55 + 4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-2.1, P ¼ 0.01) was an independent determinant of HF. The incidence of HF was 41 + 5, 46 + 7, 57 + 7, and 65 + 8% for patients without, and with mild, moderate, and severe FTR respectively (P ¼ 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5 + 2% and 60 + 3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2-2.1, P ¼ 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69 + 2.5, 67 + 2.1, 51 + 2.5, and 40 + 4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P ¼ 0.004). ConclusionsModerate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.--

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An early postoperative assessment of physical deconditioning might be able to predict the walking ability at discharge (hence, the discharge setting), in older patients undergoing major surgery.