Prognostic implications of functional mitral regurgitation according to the severity of the underlying chronic heart failure: a long‐term outcome study

Abstract

AimsTo examine the independent prognostic role of functional mitral regurgitation (FMR) and its impact across the severity of chronic heart failure (CHF) in a large population of outpatients with systolic CHF followed at two multidisciplinary clinics. Methods and resultsEchocardiography was performed upon enrolment in 469 CHF patients. Follow-up for death and heart transplant was updated on January 2007. Five-year transplant-free survival was 82.7% in patients with no or Grade I FMR, 64.4% in Grade II, 58.5% in Grade III, and 46.5% in Grade IV (P , 0.0001). There was a strong graded association between FMR and the long-term risk of death and heart transplant, which remained significant after multivariable adjustment (P ¼ 0.0003). The association between FMR and events was strong and independent in patients with less severe symptoms and in those at lower overall risk based on a propensity score analysis, while it was not significant in patients with more advanced CHF or in the high-risk subgroup (P , 0.0001 for interactions). ConclusionThis study clarifies previous apparently discrepant results by demonstrating that FMR is an independent determinant of death and heart transplantation only in less severe CHF and in patients with a lower risk profile. This finding indicates that FMR plays a major role in the early phase of CHF, suggesting that this should be the focus of strategies attempting to reduce it.--

Assessing Mitral Regurgitation in Patients with Dilated Cardiomyopathy Using 3.0T Cardiac Magnetic Resonance Imaging: Correlation with Morphological and Functional Abnormalities

“…Recognition of the presence and severity of mitral regurgitation, especially a moderate/severe degree of mitral regurgitation, can be of great value for risk stratification, treatment decisions and prognosis prediction (2,3,21). Our studies have revealed that the indexed LVESD, LAESD, and MAA min are positively correlated with increasing grades of mitral regurgitation grading, and in particular, the indexed LVESD is sufficiently sensitive to detect moderate/severe mitral regurgitation.…”

“…In DCM patients, chamber dilatation and alteration in the geometric relationship of the mitral valve apparatus may lead to mitral regurgitation, particularly MAA dilatation. According to previous studies (2,3,21), the presence of mitral regurgitation is associated with a poor outcome, and a moderate/severe degree of mitral regurgitation remains an independent predictor for sudden cardiac death, heart failure, and mortality in DCM patients. Surgical correction for severe mitral regurgitation can improve patients' symptoms and quality of life, reduce hospital mortality, and reveal reverse LV remodeling (14,22).…”

“…The increasing severity of mitral regurgitation, especially in moderate/severe patients remains an independent predictor of heart failure and sudden cardiac death (2,3). Because DCM has multiple etiologies and morphological features of the disease, the detailed mechanism for coexistence of mitral regurgitation in DCM is complex and controversial.…”

Managing Non-responders Today and What’s on the Horizon

“…Its severity in the general HF population correlates with adverse ventricular remodeling and outcomes. Bursi et al 26 showed that reduction of mitral regurgitation after CRT correlated with an improvement in survival. In contrast, a deterioration in mitral regurgitation correlated with poorer survival.…”

Die Nachsorge von Patienten nach MitraClip®-Implantation

“…Mit zunehmender New York Heart Association (NYHA)-Klasse und Schweregrad der Mitralklappeninsuffizienz steigt die Mortalität an [8,9]. Da derzeit nur die medikamentöse Therapie der Herzinsuffizienz (insbesondere mittels ACE-Hemmern) bei funktioneller Mitralklappeninsuffizienz eine medikamentöse Option bietet, stellt die operative Therapie den Goldstandard der Behandlung der schweren Mitralklappeninsuffizienz dar, zumal diese die Mortalität senkt [10][11][12].…”