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Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure

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Abstract

The goal of this study was to examine the frequency of mitral regurgitation (MR) in patients with left ventricular (LV) systolic dysfunction and to relate its presence and severity to long-term survival. Remodeling of the left ventricle after myocyte injury leads to a progressive change in LV size and shape, and it may lead to the development of MR. The frequency of MR and its relation to survival in patients with LV systolic dysfunction has not been completely characterized. We analyzed the histories, coronary anatomy, and degree of MR in patients with symptomatic heart failure and LV ejection fraction <40% who underwent cardiac catheterization between 1986 and 2000. Cox’s proportional hazards modeling was used to assess the independent effect of MR on survival. Two thousand fifty-seven patients met study criteria; MR was common in this cohort (56.2%). Of patients with MR, 811 (70.1%) had mild (grades 1+ or 2+) and 345 (29.8%) had moderate or severe (grades 3+ or 4+) regurgitation. Survival rates at 1, 3, and 5 years were significantly lower in patients with moderate to severe MR versus those with mild or no MR (p <0.001). MR was found to be an independent predictor of mortality after multivariable analysis (hazards ratio 1.23, 95% confidence interval 1.13 to 1.34, p = 0.0001). This relation of MR and survival was present in those with ischemic and nonischemic cardiomyopathies. MR is common in patients with LV systolic dysfunction and heart failure. After adjusting for other clinical variables, the presence of MR independently predicted worsened survival.

Section snippets

Patient selection

We prospectively analyzed collected data from the Duke Cardiovascular Databank on patients who underwent diagnostic cardiac catheterization in the adult catheterization laboratory at Duke University Medical Center for the evaluation of clinical heart failure (New York Heart Association [NYHA] class II to IV). Patients with a LV ejection fraction <40% were included in this analysis, and those with the following clinical characteristics were excluded: myocardial infarction within 30 days of

Frequency of MR

Two thousand and fifty-seven patients met the study criteria between January 1, 1986, and December 31, 2000 (Figure 1). Median follow-up of patients in the cohort was 3.4 years (1.4, 7.1). Of the total population, 1,156 of 2,057 subjects had MR of any grade (56.2%). Of these patients, 811 (70.1%) had mild (grades 1+ or 2+) and 345 (29.8%) had moderate or severe (grades 3+ or 4+) regurgitation.

Baseline characteristics

Table 1lists baseline characteristics for patients included in this analysis. Patients in our cohort

Discussion

Our study represents the largest analysis to date that examines the frequency of MR in patients with LV systolic dysfunction and heart failure and its effect on survival. These data demonstrate that MR, as identified by ventriculography, is very common in this population; almost 60% of these patients have MR of any grade. Most patients in whom MR was identified had a mild (grade 1+ or 2+) degree of regurgitation. In the unadjusted analysis, patients with MR of any grade had significantly worse

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