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Impact of Mitral Regurgitation on the Outcome of Patients Treated with CRT‐D: Data from the InSync ICD Italian Registry
Author(s) -
BORIANI GIUSEPPE,
GASPARINI MAURIZIO,
LANDOLINA MAURIZIO,
LUNATI MAURIZIO,
BIFFI MAURO,
SANTINI MASSIMO,
PADELETTI LUIGI,
MOLON GIULIO,
BOTTO GIANLUCA,
DE SANTO TIZIANA,
VALSECCHI SERGIO
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03280.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , mitral regurgitation , heart failure , dilated cardiomyopathy , prospective cohort study , ejection fraction , cardiomyopathy , multivariate analysis
Background: We assessed the influence of clinically significant mitral regurgitation (MR) on clinical‐echocardiographic response and outcome in heart failure (HF) patients treated with a biventricular defibrillator (cardiac resynchronization therapy defibrillator [CRT‐D]).Methods and Results: A total of 659 HF patients underwent successful implantation of CRT‐D and were enrolled in a multicenter prospective registry (median follow‐up of 15 months). Following baseline echocardiographic evaluation, patients were stratified into two groups according to the severity of MR: 232 patients with more than mild MR (Group MR+: grade 2, 3, and 4 MR) versus 427 patients with mild (grade 1) or no functional MR (Group MR−). On 6‐ and 12‐month echocardiographic evaluation, MR was seen to have improved in the vast majority of MR+ patients, while it remained unchanged in most MR− patients. On 12‐month follow‐up evaluation, a comparable response to CRT was observed in the two groups, in terms of the extent of left ventricular reverse remodeling and combined clinical and echocardiographic response. During long‐term follow‐up, event‐free survival did not differ between MR+ and MR− patients, even when subpopulations of patients with ischemic heart disease and with dilated cardiomyopathy were analyzed separately. On multivariate analysis, the only independent predictor of death from any cause was the lack of β‐blocker use.Conclusions: This observational analysis supports the use of CRT‐D in HF patients with clinically significant MR; MR had no major influence on patient outcome. (PACE 2012; 35:146–154)