Persistence of secondary mitral regurgitation and response to cardiac resynchronization therapy.
OBJECTIVE
Cardiac resynchronization therapy (CRT) improves survival and quality of life in advanced heart failure (HF). Although mitral regurgitation (MR) reduction has been reported, its presence has been associated with non-response to CRT. This study was undertaken to assess the potential role of significant mitral regurgitation (SMR) persistence after CRT on clinical outcome, major arrhythmic events, and echocardiographic response in the mid-long term.


RESULTS
Seventy-six patients (28.9% women, 63 +/- 11 years) with dilated cardiomyopathy in advanced HF were included. SMR, defined as regurgitant orifice area > or =0.20 cm(2), was assessed at baseline and its evolution 6 months after CRT. Clinical outcome (cardiovascular death/HF readmission), major arrhythmic events, and echocardiographic response (reverse remodelling) were recorded on follow-up. Thirty-two patients (42.1%) presented baseline SMR, becoming non-significant in 11 of the 32 patients (34.3%) 6 months after CRT. Its persistence was associated with higher rates of clinical events (46.4 vs. 18.7%, P = 0.011), arrhythmic events (35.7 vs. 14.5%, P = 0.034), and less reverse remodelling (28.5 vs. 83.3%, P < 0.001).


CONCLUSIONS
CRT can reduce moderate or severe baseline MR to non-significant in one-third of patients. However, its persistence was associated with worse clinical evolution, greater incidence of arrhythmic events, and less reverse remodelling.
Cabrera-Bueno
Fernando
F
Servicio de Cardiologia, Hospital Universitario Virgen de la Victoria, Malaga, Spain. fjcabrera@secardiologia.es
Molina-Mora
Maria Jose
MJ
Alzueta
Javier
J
Pena-Hernandez
Jose
J
Jimenez-Navarro
Manuel
M
Fernandez-Pastor
Julia
J
Barrera
Alberto
A
de Teresa
Eduardo
E
D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016001:Confidence Intervals; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006305:Health Status Indicators; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome