Manlio Cipriani1, Maurizio Lunati1, Maurizio Landolina2, Alessandro Proclemer3, Giuseppe Boriani4,5, Renato P Ricci6, Roberto Rordorf7, Maria Vittoria Matassini1,8, Luigi Padeletti9, Saverio Iacopino10, Giulio Molon11, Giovanni B Perego12, Maurizio Gasparini13. 1. Niguarda Ca' Granda Hospital, Milan, Italy. 2. Ospedale Maggiore, Crema, Italy. 3. S. Maria della Misericordia Hospital, Udine, Italy. 4. Institute of Cardiology, University of Bologna and Azienda Ospedaliera S, Orsola-Malpighi, Bologna, Italy. 5. Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. 6. San Filippo Neri Hospital, Rome, Italy. 7. Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy. 8. Università Politecnica delle Marche, Ancona, Italy. 9. Careggi Hospital, Firenze, Italy. 10. GVM Care and Research, Città di Lecce Hospital, Lecce, Italy. 11. Ospedale Sacro Cuore, Negrar, Italy. 12. Istituto Auxologico Italiano, San Luca, Milan, Italy. 13. IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
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.
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.
Authors: Gaurav A Upadhyay; Michael Henry; Davide Genovese; Parth Desai; Jonathan Lattell; Hannah Wey; Stephanie A Besser; Zaid Aziz; Andrew D Beaser; Cevher Ozcan; Hemal M Nayak; Roberto M Lang; Roderick Tung Journal: Heart Rhythm O2 Date: 2021-07-26
Authors: Hector Cubero-Gallego; Daniel Hernandez-Vaquero; Pablo Avanzas; Marcel Almendarez; Antonio Adeba; Rebeca Lorca; Jose Rozado; Alain Escalera; Jacobo Silva; Cesar Moris; Isaac Pascual Journal: Ann Transl Med Date: 2020-08