Long‐term prognosis of medically treated patients with functional mitral regurgitation and left ventricular dysfunction

Abstract

AimsTo assess long-term prognosis in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction, receiving current standard pharmacological therapy. Methods and resultsWe prospectively enrolled 404 consecutive patients (mean age 70.2 + 10 years) with ischaemic (76.5%) and nonischaemic (23.5%) LV dysfunction (ejection fraction 34.4 + 10.8%) and at least mild MR. Results are reported at 4 years' follow-up. Survival free of all-cause mortality was 53% and cardiac death was 74%. Survival free of allcause mortality was 50% (95% CI 35 -72) for patients with moderate MR, 49% (95% CI 27-65) for severe MR, and 64% (95% CI 47-78) for mild MR (P ¼ 0.03). Survival free of cardiac death was 57% (95% CI 38-74) for patients with moderate MR, 55% (95% CI 30-77) for severe MR, and 94% (95% CI 59 -98) for mild MR (P ¼ 0.003). Moderate-to-severe MR [relative risk (RR) 2.7, 95% CI 1.2 -6.1, P ¼ 0.003] was an independent predictor of cardiac death but not of all-cause mortality. Survival free of heart failure (HF) was 32%. Survival free of HF was 20% (95% CI 17-35) for patients with moderate MR, 18% (95% CI 15-32) for severe MR, and 62% (95% CI 45 -72) for mild MR (P ¼ 0.0001). Moderate-to-severe MR (RR 3.2, 95% CI 1.9 -5.2, P ¼ 0.0001) was an independent predictor of HF. ConclusionThe mortality and morbidity of patients with LV dysfunction and FMR remain high despite current standard pharmacological therapy. Moderate-to-severe MR is an independent predictor of cardiac death and HF.--

MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

“…In high-risk patient population, MVS is technically feasible but is associated with high rates of adverse events at 30 days. Severe MR (ischemic and non-ischemic) is associated with a poor prognosis [32]. MVS can be performed in selected patients treated with optimal medical therapy [1].…”

Transcatheter Repair in Secondary Mitral Regurgitation

“…Secondary mitral regurgitation (MR) is common in patients with idiopathic or post-ischemic dilated cardiomyopathy and is associated with a poor prognosis when treated conservatively [1,2]. Secondary MR is the result of left ventricular remodelling, and the presence and severity of secondary MR reflect the extent of underlying left ventricular dilation and dysfunction [3].…”

Current Status and Clinical Development of Transcatheter Approaches for Severe Mitral Regurgitation

“…3 Regardless of its etiology, severe MR is associated with progressive LV dysfunction and congestive heart failure, ultimately leading to high rates of morbidity and mortality. 4 Current guidelines recommend surgery for moderate-to-severe (3+) or severe (4+) MR in patients with symptoms or evidence of LV dysfunction. 5, 6 However, when the MR is secondary to underlying LV dysfunction (ie, FMR), the benefit of surgery is controversial.…”