Mitral regurgitation in patients with advanced systolic heart failure
Mitral regurgitation (MR) may develop in patients with advanced systolic congestive heart failure (CHF) without organic mitral valve disease and contribute to worsening symptoms and survival. Surgical mitral annuloplasty improves symptoms in patients with advanced CHF, and percutaneous approaches to...
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| Veröffentlicht in: | Journal of cardiac failure 2004-08, Vol.10 (4), p.285-291 |
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| creator | Patel, Jeetendra B Borgeson, Daniel D Barnes, Marion E Rihal, Charanjit S Daly, Richard C Redfield, Margaret M |
| description | Mitral regurgitation (MR) may develop in patients with advanced systolic congestive heart failure (CHF) without organic mitral valve disease and contribute to worsening symptoms and survival. Surgical mitral annuloplasty improves symptoms in patients with advanced CHF, and percutaneous approaches to mitral annuloplasty are being developed. Our objective was to define the prevalence, clinical correlates, and prognostic implications of functional MR and the use of mitral annuloplasty in patients with advanced systolic CHF evaluated in a heart failure clinic.
We reviewed clinical, echocardiographic, and survival data from all patients with advanced systolic CHF (New York Heart Association class III or IV; ejection fraction ≤35%) resulting from ischemic or idiopathic cardiomyopathy who were evaluated at our heart failure clinic between January 1996 and September 2001. Of 716 patients with advanced CHF, 558 had satisfactory baseline echocardiograms performed at our institution. Among these patients, MR was severe in 24 (4.3%), moderate-severe in 70 (12.5%), moderate in 122 (21.9%), mild-moderate in 66 (11.8%), mild in 218 (39.1%), and absent or present as only a trace in 58 (10.4%). The severity of MR was confirmed by quantitative analysis in 72% of patients with hemodynamically significant MR (more than moderate). The severity of MR correlated with the severity of systolic dysfunction (
P < .001), ventricular dilatation (
P |
| doi_str_mv | 10.1016/j.cardfail.2003.12.006 |
| format | Article |
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We reviewed clinical, echocardiographic, and survival data from all patients with advanced systolic CHF (New York Heart Association class III or IV; ejection fraction ≤35%) resulting from ischemic or idiopathic cardiomyopathy who were evaluated at our heart failure clinic between January 1996 and September 2001. Of 716 patients with advanced CHF, 558 had satisfactory baseline echocardiograms performed at our institution. Among these patients, MR was severe in 24 (4.3%), moderate-severe in 70 (12.5%), moderate in 122 (21.9%), mild-moderate in 66 (11.8%), mild in 218 (39.1%), and absent or present as only a trace in 58 (10.4%). The severity of MR was confirmed by quantitative analysis in 72% of patients with hemodynamically significant MR (more than moderate). The severity of MR correlated with the severity of systolic dysfunction (
P < .001), ventricular dilatation (
P <.03), atrial dilatation (
P < .001), diastolic dysfunction (
P < .001), and pulmonary hypertension (
P < .001). Coexistent severe or moderate-severe tricuspid regurgitation was present in 25% of patients with hemodynamically significant MR. Patients with hemodynamically significant MR had higher mortality (
P
=
.03) but not when controlling for age, sex, cause, New York Heart Association class, and ejection fraction (
P
=
.95). Only 3 patients subsequently underwent mitral valve repair.
Among patients with advanced CHF, hemodynamically significant MR is common. The severity of MR did not provide independent prognostic information in this group recognized to have uniformly high mortality.</description><identifier>ISSN: 1071-9164</identifier><identifier>EISSN: 1532-8414</identifier><identifier>DOI: 10.1016/j.cardfail.2003.12.006</identifier><identifier>PMID: 15309693</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Congestive heart failure ; Echocardiography ; Female ; Heart Failure - diagnostic imaging ; Heart Failure - mortality ; Heart Failure - physiopathology ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - mortality ; Mitral Valve Insufficiency - physiopathology ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Statistics as Topic ; Stroke Volume - physiology ; Survival Analysis ; Systole - physiology ; Tricuspid valve regurgitation ; Ventricular Dysfunction - diagnostic imaging ; Ventricular Dysfunction - mortality ; Ventricular Dysfunction - physiopathology</subject><ispartof>Journal of cardiac failure, 2004-08, Vol.10 (4), p.285-291</ispartof><rights>2004 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c364t-23c572d0d9b7f01abc5ab39650640c3561130c426458d1cbcb1fe5ecf328a923</citedby><cites>FETCH-LOGICAL-c364t-23c572d0d9b7f01abc5ab39650640c3561130c426458d1cbcb1fe5ecf328a923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S107191640300808X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15309693$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Jeetendra B</creatorcontrib><creatorcontrib>Borgeson, Daniel D</creatorcontrib><creatorcontrib>Barnes, Marion E</creatorcontrib><creatorcontrib>Rihal, Charanjit S</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Redfield, Margaret M</creatorcontrib><title>Mitral regurgitation in patients with advanced systolic heart failure</title><title>Journal of cardiac failure</title><addtitle>J Card Fail</addtitle><description>Mitral regurgitation (MR) may develop in patients with advanced systolic congestive heart failure (CHF) without organic mitral valve disease and contribute to worsening symptoms and survival. Surgical mitral annuloplasty improves symptoms in patients with advanced CHF, and percutaneous approaches to mitral annuloplasty are being developed. Our objective was to define the prevalence, clinical correlates, and prognostic implications of functional MR and the use of mitral annuloplasty in patients with advanced systolic CHF evaluated in a heart failure clinic.
We reviewed clinical, echocardiographic, and survival data from all patients with advanced systolic CHF (New York Heart Association class III or IV; ejection fraction ≤35%) resulting from ischemic or idiopathic cardiomyopathy who were evaluated at our heart failure clinic between January 1996 and September 2001. Of 716 patients with advanced CHF, 558 had satisfactory baseline echocardiograms performed at our institution. Among these patients, MR was severe in 24 (4.3%), moderate-severe in 70 (12.5%), moderate in 122 (21.9%), mild-moderate in 66 (11.8%), mild in 218 (39.1%), and absent or present as only a trace in 58 (10.4%). The severity of MR was confirmed by quantitative analysis in 72% of patients with hemodynamically significant MR (more than moderate). The severity of MR correlated with the severity of systolic dysfunction (
P < .001), ventricular dilatation (
P <.03), atrial dilatation (
P < .001), diastolic dysfunction (
P < .001), and pulmonary hypertension (
P < .001). Coexistent severe or moderate-severe tricuspid regurgitation was present in 25% of patients with hemodynamically significant MR. Patients with hemodynamically significant MR had higher mortality (
P
=
.03) but not when controlling for age, sex, cause, New York Heart Association class, and ejection fraction (
P
=
.95). Only 3 patients subsequently underwent mitral valve repair.
Among patients with advanced CHF, hemodynamically significant MR is common. The severity of MR did not provide independent prognostic information in this group recognized to have uniformly high mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Congestive heart failure</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart Failure - diagnostic imaging</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Mitral Valve Insufficiency - mortality</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Multivariate Analysis</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Severity of Illness Index</subject><subject>Statistics as Topic</subject><subject>Stroke Volume - physiology</subject><subject>Survival Analysis</subject><subject>Systole - physiology</subject><subject>Tricuspid valve regurgitation</subject><subject>Ventricular Dysfunction - diagnostic imaging</subject><subject>Ventricular Dysfunction - mortality</subject><subject>Ventricular Dysfunction - physiopathology</subject><issn>1071-9164</issn><issn>1532-8414</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkLtOwzAUhi0EolB4hcoTW8LxJU6zgapykYpYuluO7bSu0qTYTlHfHlctYmQ6Z_j-c_kQmhDICRDxuMm18qZRrs0pAMsJzQHEBbohBaPZlBN-mXooSVYRwUfoNoQNAEw5lNdolCCoRMVu0PzDRa9a7O1q8CsXVXR9h12Hd6mzXQz428U1VmavOm0NDocQ-9ZpvLbKR3w8YPD2Dl01qg32_lzHaPkyX87essXn6_vseZFpJnjMKNNFSQ2Yqi4bIKrWhapZJQoQHDQrBCEMNKeCF1NDdK1r0tjC6obRqaooG6OH09id778GG6LcuqBt26rO9kOQQpTpc8ESKE6g9n0I3jZy591W-YMkII_-5Eb--pNHf5JQmfyl4OS8Yai31vzFzsIS8HQCbHpz76yXQSdPSY3zVkdpevffjh8elYT1</recordid><startdate>20040801</startdate><enddate>20040801</enddate><creator>Patel, Jeetendra B</creator><creator>Borgeson, Daniel D</creator><creator>Barnes, Marion E</creator><creator>Rihal, Charanjit S</creator><creator>Daly, Richard C</creator><creator>Redfield, Margaret M</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040801</creationdate><title>Mitral regurgitation in patients with advanced systolic heart failure</title><author>Patel, Jeetendra B ; Borgeson, Daniel D ; Barnes, Marion E ; Rihal, Charanjit S ; Daly, Richard C ; Redfield, Margaret M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c364t-23c572d0d9b7f01abc5ab39650640c3561130c426458d1cbcb1fe5ecf328a923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Congestive heart failure</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart Failure - diagnostic imaging</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Mitral Valve Insufficiency - mortality</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Multivariate Analysis</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Severity of Illness Index</topic><topic>Statistics as Topic</topic><topic>Stroke Volume - physiology</topic><topic>Survival Analysis</topic><topic>Systole - physiology</topic><topic>Tricuspid valve regurgitation</topic><topic>Ventricular Dysfunction - diagnostic imaging</topic><topic>Ventricular Dysfunction - mortality</topic><topic>Ventricular Dysfunction - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Jeetendra B</creatorcontrib><creatorcontrib>Borgeson, Daniel D</creatorcontrib><creatorcontrib>Barnes, Marion E</creatorcontrib><creatorcontrib>Rihal, Charanjit S</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Redfield, Margaret M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiac failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Jeetendra B</au><au>Borgeson, Daniel D</au><au>Barnes, Marion E</au><au>Rihal, Charanjit S</au><au>Daly, Richard C</au><au>Redfield, Margaret M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mitral regurgitation in patients with advanced systolic heart failure</atitle><jtitle>Journal of cardiac failure</jtitle><addtitle>J Card Fail</addtitle><date>2004-08-01</date><risdate>2004</risdate><volume>10</volume><issue>4</issue><spage>285</spage><epage>291</epage><pages>285-291</pages><issn>1071-9164</issn><eissn>1532-8414</eissn><abstract>Mitral regurgitation (MR) may develop in patients with advanced systolic congestive heart failure (CHF) without organic mitral valve disease and contribute to worsening symptoms and survival. Surgical mitral annuloplasty improves symptoms in patients with advanced CHF, and percutaneous approaches to mitral annuloplasty are being developed. Our objective was to define the prevalence, clinical correlates, and prognostic implications of functional MR and the use of mitral annuloplasty in patients with advanced systolic CHF evaluated in a heart failure clinic.
We reviewed clinical, echocardiographic, and survival data from all patients with advanced systolic CHF (New York Heart Association class III or IV; ejection fraction ≤35%) resulting from ischemic or idiopathic cardiomyopathy who were evaluated at our heart failure clinic between January 1996 and September 2001. Of 716 patients with advanced CHF, 558 had satisfactory baseline echocardiograms performed at our institution. Among these patients, MR was severe in 24 (4.3%), moderate-severe in 70 (12.5%), moderate in 122 (21.9%), mild-moderate in 66 (11.8%), mild in 218 (39.1%), and absent or present as only a trace in 58 (10.4%). The severity of MR was confirmed by quantitative analysis in 72% of patients with hemodynamically significant MR (more than moderate). The severity of MR correlated with the severity of systolic dysfunction (
P < .001), ventricular dilatation (
P <.03), atrial dilatation (
P < .001), diastolic dysfunction (
P < .001), and pulmonary hypertension (
P < .001). Coexistent severe or moderate-severe tricuspid regurgitation was present in 25% of patients with hemodynamically significant MR. Patients with hemodynamically significant MR had higher mortality (
P
=
.03) but not when controlling for age, sex, cause, New York Heart Association class, and ejection fraction (
P
=
.95). Only 3 patients subsequently underwent mitral valve repair.
Among patients with advanced CHF, hemodynamically significant MR is common. The severity of MR did not provide independent prognostic information in this group recognized to have uniformly high mortality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>15309693</pmid><doi>10.1016/j.cardfail.2003.12.006</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of cardiac failure, 2004-08, Vol.10 (4), p.285-291 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Aged, 80 and over Congestive heart failure Echocardiography Female Heart Failure - diagnostic imaging Heart Failure - mortality Heart Failure - physiopathology Humans Male Middle Aged Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - mortality Mitral Valve Insufficiency - physiopathology Multivariate Analysis Predictive Value of Tests Prognosis Severity of Illness Index Statistics as Topic Stroke Volume - physiology Survival Analysis Systole - physiology Tricuspid valve regurgitation Ventricular Dysfunction - diagnostic imaging Ventricular Dysfunction - mortality Ventricular Dysfunction - physiopathology |
| title | Mitral regurgitation in patients with advanced systolic heart failure |
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