Mitral insufficiency and morbidity and mortality in left ventricular dysfunction.
BACKGROUND
Mitral insufficiency is known to occur in a substantial proportion of patients with heart failure. Its relationship with morbidity and mortality is poorly described.


METHODS
The mortality and hospitalization for heart failure were retrospectively examined in patients who underwent baseline echocardiography in the Studies Of Left Ventricular Dysfunction (SOLVD) treatment and prevention trials. The presence and grade of mitral insufficiency was assessed, and patients with and without mitral insufficiency were compared.


RESULTS
Patients with left ventricular dysfunction and mitral insufficiency had greater than twofold increased risk of death or admission for heart failure over two years (RR 2.38, 95% CI 1.43 to 3.97). This excess risk persisted after adjustment for the severity of heart failure, etiology and differences in treatment (RR 1.82, 95% CI 1.04 to 3.17; P=0.04). The presence of moderate mitral insufficiency versus no insufficiency was associated with even greater independent risk (RR 2.20, 95% CI 1.01 to 4.80; P=0.05). Results were consistent with binary and ordinal analysis of mitral insufficiency.


CONCLUSIONS
The presence of mitral insufficiency in patients with left ventricular dysfunction is independently associated with adverse outcomes, including death and hospitalization for heart failure. This has potentially important clinical implications for the assessment and management of patients with heart failure.
Baskett
Roger J F
RJ
Maritime Heart Centre and the Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada. rogerbaskett@hotmail.com
Exner
Derek V
DV
Hirsch
Gregory M
GM
Ghali
William A
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality
D004656:Enalapril
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