Key result
Mitral valve repair was associated with a lower risk of all-cause death or unplanned heart failure hospitalization compared to medical therapy (44.8% vs 68.5%; HR 0.28; 95% CI 0.14-0.55; p<.001).
Why the study?
Patients with functional mitral regurgitation and nonischemic dilated cardiomyopathy have high mortality, but clinical outcomes between different treatment strategies and predictors of adverse outcomes needed evaluation.
Does mitral valve repair reduce all-cause death or unplanned hospitalization for heart failure in patients with moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy compared to medical therapy?
Cohort (n=112)
Does mitral valve repair reduce all-cause death or unplanned hospitalization for heart failure in patients with moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy compared to medical therapy?
Hazard Ratio: 0.28 (95% CI 0.14–0.55)
Absolute Event Rate: 44.8% vs 68.5%
p-value: p=<.001
Mitral valve repair is associated with a significantly better prognosis compared to medical therapy alone in patients with moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy.
Supports risk stratification in FMR with nonischemic DCM; leaves open optimal treatment selection pending randomized data.
BACKGROUND: Patients with functional mitral regurgitation (FMR) and nonischemic dilated cardiomyopathy (DCM) are associated with high mortality. OBJECTIVES: Our study aimed to compare the clinical outcomes between different treatment strategies and identify predictors associated with the adverse outcomes. METHODS: A total of 112 patients with moderate or severe FMR and nonischaemic DCM were included in our study. The primary composite outcome was all-cause death or unplanned hospitalization for heart failure. The secondary outcomes were individual components of the primary outcome and the cardiovascular death. RESULTS: In this study, the primary composite outcome occurred in 26 patients (44.8%) in mitral valve repair (MVr) group and 37 patients (68.5%) in medical group (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.14-0.55; p < .001). The 1-, 3-, and 5-year survival rates for patients with MVr were 96.6%, 91.8%, and 77.4%, respectively, which were significantly higher than that of medical group: 81.2%, 71.9%, and 65.1%, respectively (HR, 0.32; 95% CI, 0.12-0.87; p = .03). Left ventricular ejection fraction (LVEF) < 41.5% (p < .001) and atrial fibrillation (p = .02) were independently associated with the primary outcome. LVEF < 41.5% (p = .007), renal insufficiency (p = .003), and left ventricular end-diastolic diameter > 66.5 mm (p < .001) were independently associated with heightened risk for all-cause death. CONCLUSION: Compared with medical therapy, MVr was associated with a better prognosis in patients with moderate or severe FMR and nonischemic DCM. We observed that LVEF < 41.5% was the only independent predictor of the primary outcome and all individual components of secondary outcomes.
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Li et al. (2023) conducted a cohort in Moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy (n=112). Mitral valve repair (MVr) vs. Medical therapy was evaluated on All-cause death or unplanned hospitalization for heart failure (HR 0.28, 95% CI 0.14-0.55, p=<.001). Mitral valve repair was associated with a lower risk of all-cause death or unplanned heart failure hospitalization compared to medical therapy (44.8% vs 68.5%; HR 0.28; 95% CI 0.14-0.55; p<.001).
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