© 2005 European Society of Cardiology
Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure
a Department of Cardiology, "Villa Bianca" Hospital via Piave 78, 38100, Trento, Italy
b Department of Cardiology, "S. Martino" Hospital Belluno, Italy
c Department of Cardiology, "Salvatore Maugeri" Foundation IRCCS, Pavia Medical Center, Italy
d Department of Cardiology, "S. Camillo" Hospital Italy
e Department of Cardiology INRCA IRCCS Roma Italy
f Department of Cardiology, "Riuniti" Hospital Trieste, Italy
* Corresponding auhtor. Tel.: +39 461 916000; fax: +39 461 916874. E-mail address: gcioffi{at}villabiancatrento.it
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Abstract |
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Background and aim: Mitral regurgitation (MR) has been demonstrated to be a powerful predictor of adverse outcome in middle-aged patients with chronic heart failure (CHF). In this study, we sought to define the prognostic impact of functional mitral regurgitation in a population of elderly patients with systolic CHF.
Methods: One hundred seventy-five outpatients aged >70 years with validated CHF and left ventricular ejection fraction <40% underwent clinical and echocardiographic evaluations at baseline. Mitral regurgitation was diagnosed by Color Doppler and quantified in 5 categorical values using a 0–4+ grading system. Outcome measures included 1-year mortality and hospitalization for worsening CHF.
Results: The distribution of patients according to the 5 different degrees of MR detected at baseline was: absent=11%, 1+=31%, 2+=38%, 3+=16%, 4+=4%. The relationship between MR and mortality was direct and approximately linear (r=0.39, p=0.00001). The prevalence of death in the 5 subgroups was 0%, 7%, 15%, 45%, 57%, respectively. Multivariate logistic regression analysis showed that MR was the strongest predictor of death (OR 4.47, 95% CI 1.50–13.0), independently of the presence of diabetes mellitus, older age and larger left ventricular end-diastolic volume. No association was found between MR and hospitalization for worsening CHF (r=0.08, p=0.41).
Conclusions: This study establishes the direct and independent relationship between MR severity and one-year mortality among elders with systolic CHF. Conversely, MR does not provide useful information regarding the risk of subsequent hospitalization for worsening CHF.
Key Words: Mitral regurgitation • Heart failure • Elderly population • Left ventricular systolic dysfunction
Received September 30, 2004; Revised December 8, 2004; Accepted January 27, 2005
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