Improvement in mitral regurgitation after CRT was associated with better long-term survival and significantly reduced mortality risk (HR 3.58) in patients with heart failure.
Does improvement in mitral regurgitation after cardiac resynchronization therapy reduce the composite of death, transplant, or LVAD in patients with heart failure?
Persistent significant mitral regurgitation after cardiac resynchronization therapy is strongly associated with worse long-term survival, and baseline echocardiographic features can predict which patients will experience MR improvement.
Absolute Event Rate: 0% vs 0%
Background— Mechanisms of mitral regurgitation (MR) reduction with cardiac resynchronization therapy (CRT) are complex, and their association with long-term outcome is unclear. We sought to elucidate mechanistic features of reduction in MR with CRT, which impact long-term patient survival. Methods and Results— A prospective longitudinal study of 277 patients with heart failure with QRS width ≥120 ms and ejection fraction ≤35% for CRT was performed. Quantitative echocardiography, including dyssynchrony analysis, was performed at baseline. MR was quantified by color Doppler before and 6 months after CRT. Predefined end points of death, transplant, or left ventricular assist device were tracked during 4 years. There were 114 (48%) patients with CRT with significant MR (≥moderate) at baseline; of whom 48 (42%) patients had MR improvement, and 24 (19%) patients had MR worsening after CRT. The 66 events (47 deaths, 10 transplantations, and 9 left ventricular assist devices) were strongly associated with significant MR after CRT (hazard ratio, 3.58; 95% confidence interval, 2.18–5.87; P 200 ms, lack of severe left ventricular dilatation (end-systolic dimension index <29 mm/m 2 ), and lack of echocardiographic scar at papillary muscle insertion sites (all P <0.05) and, when combined, were additively associated with long-term survival ( P =0.0001). Conclusions— Significant MR after CRT was strongly associated with less favorable long-term survival. Echocardiographic mechanistic features were identified that were associated with improvement in MR after CRT and favorable long-term survival.
Onishi et al. (Tue,) reported a other. Improvement in mitral regurgitation after CRT was associated with better long-term survival and significantly reduced mortality risk (HR 3.58) in patients with heart failure.