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 language | English |
|---|---|
| Pages (from-to) | 1060-1068 |
| Number of pages | 9 |
| Journal | European Journal of Heart Failure |
| Volume | 18 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 1 2016 |
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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 journal › Article
}
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
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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 -