Dilated cardiomyopathy with mitral regurgitation: Decreased survival despite a low frequency of left ventricular thrombus

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Abstract

Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 ± 7 vs 9 ± 7 cm/sec; systole 29 ± 12 vs 16 ± 13 cm/sec; p < 0.001 for both), accounting for the rarity of thrombi in this group. Follow-up data on 89% of the patients showed markedly decreased survival in the group with MR (22% vs 60% at 32 ± 6 months, p < 0.005), and this was evident even in patients with mild MR. Thus although MR is a noninvasively obtainable marker of a large subgroup of patients with dilated cardiomyopathy “protected” from left ventricular thrombus formation, it is a sensitive marker of decreased survival.

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    Citation Excerpt :

    The presence of FMR is clinically important because patients with congestive heart failure who have FMR have a variety of worse clinical outcomes and associated high-risk features. Compared with patients without FMR, patients with FMR have a higher risk of mortality,1–4,7 poorer exercise performance3,8 and functional class,1–4 a higher prevalence of tricuspid regurgitation,1,4 worsened hemodynamic parameters,3 and larger left atrial and ventricular chamber sizes.6,8 These parameters are all associated with worse clinical outcomes.9

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Supported in part by the Women's League for Medical Research, Albert Einstein Medical Center.

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