title: Impact of mitral regurgitation on the outcome of patients treated with CRT-D: data from the InSync ICD Italian Registry.
abstract: BACKGROUND
  We assessed the influence of clinically significant mitral regurgitation (MR) on clinical-echocardiographic response and outcome in heart failure (HF) patients treated with a biventricular defibrillator (cardiac resynchronization therapy defibrillator [CRT-D]).
  
  
  RESULTS
  A total of 659 HF patients underwent successful implantation of CRT-D and were enrolled in a multicenter prospective registry (median follow-up of 15 months). Following baseline echocardiographic evaluation, patients were stratified into two groups according to the severity of MR: 232 patients with more than mild MR (Group MR+: grade 2, 3, and 4 MR) versus 427 patients with mild (grade 1) or no functional MR (Group MR-). On 6- and 12-month echocardiographic evaluation, MR was seen to have improved in the vast majority of MR+ patients, while it remained unchanged in most MR- patients. On 12-month follow-up evaluation, a comparable response to CRT was observed in the two groups, in terms of the extent of left ventricular reverse remodeling and combined clinical and echocardiographic response. During long-term follow-up, event-free survival did not differ between MR+ and MR- patients, even when subpopulations of patients with ischemic heart disease and with dilated cardiomyopathy were analyzed separately. On multivariate analysis, the only independent predictor of death from any cause was the lack of β-blocker use.
  
  
  CONCLUSIONS
  This observational analysis supports the use of CRT-D in HF patients with clinically significant MR; MR had no major influence on patient outcome.
authors: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. giuseppe.boriani@unibo.it
authors: Giuseppe
authors: G
authors: Boriani
authors: Maurizio
authors: M
authors: Gasparini
authors: Maurizio
authors: M
authors: Landolina
authors: Maurizio
authors: M
authors: Lunati
authors: Mauro
authors: M
authors: Biffi
authors: Massimo
authors: M
authors: Santini
authors: Luigi
authors: L
authors: Padeletti
authors: Giulio
authors: G
authors: Molon
authors: Gianluca
authors: G
authors: Botto
authors: Tiziana
authors: T
authors: de Santo
authors: Sergio
authors: S
authors: Valsecchi
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome