Effect of Functional Mitral Regurgitation on Outcome in Patients Receiving Cardiac Resynchronization Therapy for Heart Failure

Functional mitral regurgitation (FMR) is common in heart failure (HF), and negatively impacts prognosis. Cardiac resynchronization therapy (CRT) can improve FMR, but the long-term changes in and impact of FMR after CRT are still unclear. The present study investigated the prevalence, evolution and i...

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Bibliographic Details
Published in:The American journal of cardiology 2019-01, Vol.123 (1), p.75-83
Main Authors: van der Bijl, Pieter, Khidir, Mand, Ajmone Marsan, Nina, Delgado, Victoria, Leon, Martin B., Stone, Gregg W., Bax, Jeroen J.
Format: Article
Language:English
Subjects:
Body mass index
Cardiac arrhythmia
Cardiomyopathy
Cardiovascular disease
Confidence intervals
Coronary artery disease
Diabetes
Etiology
Evolution
Heart
Heart diseases
Heart failure
Hemoglobin
Implantation
Ischemia
Laboratories
Medical prognosis
Mortality
Patients
Regurgitation
Therapy
Ultrasonic imaging
Ventricle
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Summary:Functional mitral regurgitation (FMR) is common in heart failure (HF), and negatively impacts prognosis. Cardiac resynchronization therapy (CRT) can improve FMR, but the long-term changes in and impact of FMR after CRT are still unclear. The present study investigated the prevalence, evolution and impact on mortality of FMR before and after CRT in patients with HF. A total of 1,313 patients (66 ± 11 years, 77% male, 59% ischemic heart disease) treated with CRT were evaluated. Patients were divided into 4 groups of FMR according to the evolution at 6 months after CRT: no or mild FMR at baseline which remained unchanged at 6 months (grade 0–1 FMR unchanged, n = 609 [51%]), no or mild FMR which worsened to moderate to severe (grade 0–1 FMR worsened, n = 66 [6%)]), moderate to severe FMR which improved to no or mild (grade 2–4 improved, n = 209 [18%]), and moderate to severe FMR which remained unchanged (grade 2–4 unchanged, n = 309 [26%]). Over a mean follow-up of 51 ± 38 months, 297 (25%) patients died. Those with baseline FMR grade 0–1 which remained unchanged at 6-month follow-up, as well as baseline FMR grade 2–4 which improved, had lower mortality rates than patients with 6-month FMR grade 2–4 regardless of baseline FMR grade (p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2018.09.020