title: Prognostic implications of mitral regurgitation in patients after cardiac resynchronization therapy.
abstract: Mitral regurgitation (MR) is a common finding in patients with heart failure with debatable effects on prognosis. Reduction in MR is one of the mechanisms by which cardiac resynchronization therapy (CRT) exerts its beneficial effects. We investigated the prognostic impact of baseline MR and MR persistence after CRT on outcomes of treated patients.
  
  
  
  We prospectively followed 1122 CRT patients (66.4 ± 10.3 years, 78% male) who were stratified according to baseline MR severity as having MR- (degree 0-1; n = 508, 45%) or MR+ (degrees 2-3-4; n = 614, 55%). In 916 patients (82%) with MR severity data available at 1-year follow-up, the annual mortality rate was 3.4 and 6.0 per patient-year in the MR- and MR+ group, respectively, with a 1-year incidence rate ratio (IRR) of 1.76 (P < 0.001). Similar results were observed for cardiovascular mortality (1-year IRR 1.72, P = 0.002). When considering survival according to MR severity after CRT, all-cause and cardiovascular mortality were lower in the improved than in the worsened group (1-year IRR 1.87 and 2.33, respectively; both P < 0.001). Regression analysis showed that absence of MR improvement at follow-up was a significant independent predictor of both all-cause and cardiovascular mortality.
  
  
  
  Baseline significant MR and absence of MR improvement after CRT are strongly predictive of less favourable long-term survival.
authors.affiliation: Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Manlio
authors.initials: M
authors.lastname: Cipriani
authors.affiliation: Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.affiliation: Ospedale Maggiore, Crema, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.affiliation: S. Maria della Misericordia Hospital, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.affiliation: Institute of Cardiology, University of Bologna and Azienda Ospedaliera S, Orsola-Malpighi, Bologna, Italy.|Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: San Filippo Neri Hospital, Rome, Italy.
authors.forename: Renato P
authors.initials: RP
authors.lastname: Ricci
authors.affiliation: Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rordorf
authors.affiliation: Niguarda Ca' Granda Hospital, Milan, Italy.|Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Matassini
authors.affiliation: Careggi Hospital, Firenze, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.affiliation: GVM Care and Research, Città di Lecce Hospital, Lecce, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Iacopino
authors.affiliation: Ospedale Sacro Cuore, Negrar, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.affiliation: Istituto Auxologico Italiano, San Luca, Milan, Italy.
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Perego
authors.affiliation: IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology*; D009026:Mortality; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Heart failure; Mitral regurgitation; Prognosis