title: Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.
abstract: BACKGROUND
  Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF), but its effect on outcome is still uncertain, mainly because in previous studies sample sizes were relatively small and semiquantitative methods for FMR grading were used.
  
  
  OBJECTIVE
  To evaluate the prognostic value of FMR in patients with HF.
  
  
  RESULTS
  Patients with HF due to ischaemic and non-ischaemic dilated cardiomyopathy (DCM) were retrospectively recruited. The clinical end point was a composite of all-cause mortality and hospitalisation for worsening HF. FMR was quantitatively determined by measuring vena contracta (VC) or effective regurgitant orifice (ERO) or regurgitant volume (RV). Severe FMR was defined as ERO >0.2 cm(2) or RV >30 ml or VC >0.4 cm. Restrictive mitral filling pattern (RMP) was defined as E-wave deceleration time <140 ms. The study population comprised 1256 patients (mean age 67 ± 11; 78% male) with HF due to DCM: 27% had no FMR, 49% mild to moderate FMR and 24% severe FMR. There was a powerful association between severe FMR and prognosis (HR = 2.0, 95% CI 1.5 to 2.6; p<0.0001) after adjustment of left ventricular ejection fraction and RMP. The independent association of severe FMR with prognosis was confirmed in patients with ischaemic DCM (HR = 2.0, 95% CI 1.4 to 2.7; p<0.0001) and non-ischaemic DCM (HR = 1.9, 95% CI 1.3 to 2.9; p = 0.002).
  
  
  CONCLUSIONS
  In a large patient population it was shown that a quantitatively defined FMR was strongly associated with the outcome of patients with HF, independently of LV function.
authors.affiliation: Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Verona, Italy. andrea.rossi@ospedaleuniverona.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Frank L
authors.initials: FL
authors.lastname: Dini
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Silvia
authors.initials: S
authors.lastname: Frattini
authors.forename: Anca
authors.initials: A
authors.lastname: Simioniuc
authors.forename: Mariangela
authors.initials: M
authors.lastname: Gullace
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*