Key result
Cardiac resynchronization therapy significantly reduced the risk of all-cause mortality (HR 0.22) in patients with non-ischemic functional mitral regurgitation and heart failure.
Why the study?
Non-ischemic functional mitral regurgitation carries dire long-term consequences, but its long-term follow-up outcomes and prognostic predictors required investigation.
Cohort (n=200)
No
Hazard Ratio: 0.22 (95% CI 0.072–0.675)
p-value: p=0.008
In patients with non-ischemic functional mitral regurgitation, guideline-directed medical therapy and CRT significantly improve MR severity and NYHA class, with CRT and hydralazine acting as independent predictors of reduced all-cause mortality.
Prognosis predictors may aid risk stratification in non-ischemic FMR; leaves open optimal therapy selection pending prospective trials.
Purpose: Non-ischemic Functional Mitral Regurgitation (FMR) is accompanied by dire long-term consequences. The treatment revolves around correcting the underlying LV dysfunction. This study reports long-term follow-up outcomes and prognosis predictors of non-ischemic FMR. Methods: We enrolled 200 patients with at-least-moderate non-ischemic FMR, undergoing medical treatment and/or cardiac resynchronization therapy (CRT) between 2003 and 2019. MR severity and LV dysfunction parameters were obtained. The endpoint outcomes were all-cause mortality, stroke, all-cause rehospitalization, and the need for heart transplantation. Results: Two hundred participants, 104 (52%) men and 96 (48%) women with the median age of 61 years (IQR 50-70) at diagnosis and the median follow-up of 2 years (IQR 1-4), were enrolled. The all-cause mortality, all-cause rehospitalization, and need for heart transplantation were significantly associated with lower LVEF and TAPSE at diagnosis (P-value<0.05). Furthermore, baseline MR severity was significantly associated with the incidence of stroke (P-value =0.026) and the all-cause rehospitalization (P-value<0.001).The MR severity, NYHA classification, LVEDD, and TAPSE improved at the follow-up (P-value<0.001). ACEi/ARB (P-value =0.008), Nitrate (P-value =0.001), and Hydralazine (P-value =0.006) were associated with MR severity improvement. CRT (HR=0.22, P-value=0.008) and Hydralazine (HR=0.25, P-value=0.038) were the independent negative predictors of all-cause mortality. Ultimately, a significant difference was observed between survival free of all causes according to the LVEF (P-value=0.041). Conclusion: We detected a significant decline in MR severity and NYHA classification during follow-up. Overall, the FMR-associated mortality risk will be significantly reduced by closely sticking to the treatment guidelines in a tertiary heart center.
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Hosseini et al. (2022) conducted a cohort in Non-ischemic Functional Mitral Regurgitation (n=200). Cardiac resynchronization therapy (CRT) vs. No CRT was evaluated on All-cause mortality (HR 0.22, 95% CI 0.072-0.675, p=0.008). Cardiac resynchronization therapy significantly reduced the risk of all-cause mortality (HR 0.22) in patients with non-ischemic functional mitral regurgitation and heart failure.
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