title: Early improvement of functional mitral regurgitation in patients with idiopathic dilated cardiomyopathy.
abstract: The aim of the study was to assess the clinical and prognostic impact of early functional mitral regurgitation (FMR) improvement on the outcome of patients with idiopathic dilated cardiomyopathy (IDC). The prevalence and prognostic role of FMR improvement, particularly at early follow-up, in patients with IDC are still unclear. From 1988 to 2009, we enrolled 470 patients with IDC with available FMR data at baseline and after 6 ± 2 months. According to the evolution of FMR, patients were classified into 3 groups: stable absent-mild FMR, early FMR improvement (downgrading from moderate-severe to absent-mild), and persistence/early development of moderate-severe FMR. At baseline, 177 of 470 patients (38%) had moderate-severe FMR. Patients with early FMR improvement had significantly better survival rate-free from heart transplant with respect to those with persistence/early development of moderate-severe FMR (93%, 81%, and 66% vs 91%, 64%, and 52% at 1, 6, and 12 years, respectively; p = 0.044). At 6-month follow-up multivariate analysis, FMR improvement was associated with better prognosis (hazard ratio 0.78, 95% confidence interval [CI] 0.64 to 0.96, p = 0.02); the other independent predictors were male gender, heart failure duration, and early re-evaluation of the New York Heart Association class and left ventricle systolic function. This model provided more accurate risk stratification compared with the baseline model (Net Reclassification Index 80% at 12 months and 41% at 72 months). In conclusion, in a large cohort of patients with IDC receiving optimal medical treatment, early improvement of FMR was frequent (53%) and emerged as a favorable independent prognostic factor with an incremental short- and long-term power compared with the baseline evaluation.
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: davide.stolfo@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Stolfo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Poli
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Gigli
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy; Cardiovascular Center, A.S.S.1, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fabris
authors.affiliation: Cardiovascular Center, A.S.S.1, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*