Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy

Manlio Cipriani, M. Lunati, Maurizio Eugenio Landolina, Alessandro Proclemer, Giuseppe Boriani, Renato P. Ricci, Roberto Rordorf, Maria Vittoria Matassini, Luigi Padeletti, Saverio Iacopino, Giulio Molon, Giovanni Battista Perego, Maurizio Gasparini

Research output: Contribution to journalArticle

Abstract

Aim: 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. Methods and results: 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. Conclusions: Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.

Original languageEnglish
Pages (from-to)1060-1068
Number of pages9
JournalEuropean Journal of Heart Failure
Volume18
Issue number8
DOIs
Publication statusPublished - Aug 1 2016

Fingerprint

Cardiac Resynchronization Therapy
Mitral Valve Insufficiency
Mortality
Incidence
Survival

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Mitral regurgitation
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy. / Cipriani, Manlio; Lunati, M.; Landolina, Maurizio Eugenio; Proclemer, Alessandro; Boriani, Giuseppe; Ricci, Renato P.; Rordorf, Roberto; Matassini, Maria Vittoria; Padeletti, Luigi; Iacopino, Saverio; Molon, Giulio; Perego, Giovanni Battista; Gasparini, Maurizio.

In: European Journal of Heart Failure, Vol. 18, No. 8, 01.08.2016, p. 1060-1068.

Research output: Contribution to journalArticle

Cipriani, M, Lunati, M, Landolina, ME, Proclemer, A, Boriani, G, Ricci, RP, Rordorf, R, Matassini, MV, Padeletti, L, Iacopino, S, Molon, G, Perego, GB & Gasparini, M 2016, 'Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy', European Journal of Heart Failure, vol. 18, no. 8, pp. 1060-1068. https://doi.org/10.1002/ejhf.569
Cipriani, Manlio ; Lunati, M. ; Landolina, Maurizio Eugenio ; Proclemer, Alessandro ; Boriani, Giuseppe ; Ricci, Renato P. ; Rordorf, Roberto ; Matassini, Maria Vittoria ; Padeletti, Luigi ; Iacopino, Saverio ; Molon, Giulio ; Perego, Giovanni Battista ; Gasparini, Maurizio. / Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy. In: European Journal of Heart Failure. 2016 ; Vol. 18, No. 8. pp. 1060-1068.
@article{557936fce98544679466726c48d5da76,
title = "Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy",
abstract = "Aim: 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. Methods and results: 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. Conclusions: Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.",
keywords = "Cardiac resynchronization therapy, Heart failure, Mitral regurgitation, Prognosis",
author = "Manlio Cipriani and M. Lunati and Landolina, {Maurizio Eugenio} and Alessandro Proclemer and Giuseppe Boriani and Ricci, {Renato P.} and Roberto Rordorf and Matassini, {Maria Vittoria} and Luigi Padeletti and Saverio Iacopino and Giulio Molon and Perego, {Giovanni Battista} and Maurizio Gasparini",
year = "2016",
month = "8",
day = "1",
doi = "10.1002/ejhf.569",
language = "English",
volume = "18",
pages = "1060--1068",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "John Wiley & Sons, Ltd",
number = "8",

}

TY - JOUR

T1 - Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy

AU - Cipriani, Manlio

AU - Lunati, M.

AU - Landolina, Maurizio Eugenio

AU - Proclemer, Alessandro

AU - Boriani, Giuseppe

AU - Ricci, Renato P.

AU - Rordorf, Roberto

AU - Matassini, Maria Vittoria

AU - Padeletti, Luigi

AU - Iacopino, Saverio

AU - Molon, Giulio

AU - Perego, Giovanni Battista

AU - Gasparini, Maurizio

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Aim: 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. Methods and results: 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. Conclusions: Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.

AB - Aim: 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. Methods and results: 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. Conclusions: Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Mitral regurgitation

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=84981725672&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981725672&partnerID=8YFLogxK

U2 - 10.1002/ejhf.569

DO - 10.1002/ejhf.569

M3 - Article

VL - 18

SP - 1060

EP - 1068

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 8

ER -