Abstract
Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effects on prognosis. Reduction in MR is one of the mechanisms by which cardiac resynchronization therapy (CRT) exerts its beneficial effects. We investigated the prognostic impact of baseline MR and MR persistence after CRT on outcomes of treated patients. We prospectively followed 1122 CRT patients (66.4 ± 10.3 years, 78% male) who were stratified according to baseline MR severity as having MR- (degree 0-1; n = 508, 45%) or MR+ (degrees 2-3-4; n = 614, 55%). In 916 patients (82%) with MR severity data available at 1-year follow-up, the annual mortality rate was 3.4 and 6.0 per patient-year in the MR- and MR+ group, respectively, with a 1-year incidence rate ratio (IRR) of 1.76 (P < 0.001). Similar results were observed for cardiovascular mortality (1-year IRR 1.72, P = 0.002). When considering survival according to MR severity after CRT, all-cause and cardiovascular mortality were lower in the improved than in the worsened group (1-year IRR 1.87 and 2.33, respectively; both P < 0.001). Regression analysis showed that absence of MR improvement at follow-up was a significant independent predictor of both all-cause and cardiovascular mortality. Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.
Highlights
Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF) reported in up to 35% of affected patients in its moderate to severe form.[1,2] Left ventricular systolic dysfunction and dyssynchrony, changes in ventricular shape and size, and mitral annulus dilatation are responsible for the imbalance between closing and tethering forces that act on mitral valve competency, resulting in FMR.[3]
Baseline significant MR and absence of MR improvement after Cardiac resynchronization therapy (CRT) are strongly predictive of less favourable long-term
The aim of our research was to assess, in a large real-world cohort of patients treated with CRT, the impact of significant pre-implantation MR on mortality and to test the hypothesis that persistent MR after CRT is associated with unfavourable clinical outcomes
Summary
Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF) reported in up to 35% of affected patients in its moderate to severe form.[1,2] Left ventricular systolic dysfunction and dyssynchrony, changes in ventricular shape and size, and mitral annulus dilatation are responsible for the imbalance between closing and tethering forces that act on mitral valve competency, resulting in FMR.[3]. Cardiac resynchronization therapy (CRT) is a recognized milestone in the treatment of advanced HF patients, and recently for less severely affected patients,[9,10] on top of optimal pharmacological therapy, and is Patient population and project design. Patients participating in the Italian ClinicalService Project (ClinicalTrials.gov Identifier: NCT01007474), a national medical care project aiming to improve the quality of diagnostic and therapeutic strategies using implantable cardiac devices in clinical practice, were considered for the present analysis. The project consists of a shared environment for the collection, management, analysis and reporting of data from patients in whom Medtronic devices have been implanted. An independent scientific committee of physicians prospectively identifies key clinical questions on a yearly basis for analysis and publication. A charter assigns the ownership of data to the centres and governs the conduct and relationship of the scientific committee and Medtronic. Each patient provided informed consent for data collection and analysis
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