Natural history of moderate to severe mitral regurgitation in patients with cardiomyopathy followed at tertiary care heart failure clinic

Abstract

Study objective To determine the proportion of patients with cardiomyopathy and mitral regurgitation of higher degree followed at tertiary care clinic who improve left ventricular function and or reduce mitral regurgitation grade. To determine clinical and echocardiographic predictors of improvement or deterioration. Patients cohort Patients with cardiomyopathy and heart failure NYHA class II to IV, left ventricular ejection fraction less or equal to 40%. Total number of 42 patients met the criteria of moderate to severe mitral regurgitation, whose follow-up echocardiography was performed 3 to 12 months after the entry investigation and revealed improvement or deterioration of left ventricular function and mitral regurgitation grade. Results Mitral regurgitation grade improved in 10 patients (24%), left ventricular function improved in 9 (21%) patients. The combined improvement of left ventricular function and mitral regurgitation grade was assessed in 13 patients (30%), 29 patients did not manifest any improvement throughout the follow-up. Statistical analysis evaluating clinical and echocardiographic parameters revealed significant difference between group of improvement and group with deterioration in left atrial diameter at the baseline ( p < 0.02). This result was influenced by gender distribution in the groups (decrease in statistical significance to p = 0.067). Conclusion Improvement of left ventricular function and mitral regurgitation grade was identified in 30% of the patients with cardiomyopathy and moderate to severe mitral regurgitation. No predictors of improvement or deterioration were identified among the clinical and echocardiographic variables.