| Mitral effective regurgitant orifice area versus left ventricular ejection fraction as prognostic indicators in patients with dilated cardiomyopathy and heart failure. | |
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MedLine Citation:
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PMID: 15626272 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: This study aimed at investigating the relative powers of the quantitative evaluation of functional mitral regurgitation (FMR) and ejection fraction (EF) in predicting the clinical changes and prognosis of dilated cardiomyopathy (DCM) with severe systolic dysfunction. METHODS: A total of 81 patients with DCM, EF < 0.40 and at least mild FMR were prospectively evaluated during a mean follow-up of 24 +/- 7 months. Twenty cardiac deaths were recorded. At the time of enrolment all patients underwent echocardiographic evaluation of the effective regurgitant orifice area (ERO), EF, left atrial area, and tenting area. In 42/81 patients, the data obtained at enrolment were compared to those measured at a mean follow-up of 10 +/- 2 months. A multivariate analysis was performed to determine the best predictor of NYHA class and mortality. RESULTS: There was a correlation between the NYHA class and the ERO (chi2 = 26.1, p = 0.0001) but not with EF (chi2 = 4.3, p = 0.22) and at multivariate analysis, the ERO was found to be the main determinant of the NYHA class (r = 0.64, standard error 0.6, p = 0.0001). The NYHA class remained unchanged or improved in 28/42 (67%) and deteriorated in 14/42 (33%) patients. In the first group, the ERO increased from 22.3 +/- 10 to 30.2 +/- 16.4 mm2 (p = 0.05) and the tenting area from 5.8 +/- 1.8 to 6.8 +/- 1.8 cm2 (p = 0.001); in the second group, the ERO increased from 25.1 +/- 5.6 to 39.0 +/- 14.5 mm2 (p = 0.04) and the tenting area from 5.9 +/- 2.1 to 7.6 +/- 1.8 cm2 (p = 0.0001), in both groups without significant changes in EF. The mortality was 8.1% in patients with an ERO < 21 mm2, 30.3% in patients with an ERO of 21-30 mm2, and 50% in those with an ERO > 30 mm2. The EF was similar in the three subgroups. At Cox multivariate analysis the best predictors of mortality were the ERO (chi2 = 13.83, p = 0.0001), EF (chi2 = 5.48, p = 0.019), and left atrial area (chi2 = 4.52, p = 0.04). CONCLUSIONS: FMR in DCM well correlated with the clinical status of the patients and its worsening was suggestive of progression of the disease. The ERO was found to be the best predictor of the NYHA class and mortality. |
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Authors:
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Flavio Venturi; Maria Luisa Gianfaldoni; Giovanni Melina; Andrea Cecchi; Nunzia Rosa Petix; Anna Monopoli; Andrea Taiti; Vincenzo Mazzoni; Fabio Fantini |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Italian heart journal : official journal of the Italian Federation of Cardiology Volume: 5 ISSN: 1129-471X ISO Abbreviation: Ital Heart J Publication Date: 2004 Oct |
Date Detail:
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Created Date: 2004-12-31 Completed Date: 2005-04-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 100909716 Medline TA: Ital Heart J Country: Italy |
Other Details:
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Languages: eng Pagination: 755-61 Citation Subset: IM |
Affiliation:
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Division of Cardiology, San Giuseppe Hospital, ASL11, Empoli, FI, Italy. flavio.venturi3@tin.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiomyopathy, Dilated / mortality, physiopathology* Disease Progression Female Heart Failure / mortality, physiopathology* Humans Male Mitral Valve Insufficiency / physiopathology* Prognosis Prospective Studies Stroke Volume / physiology* Survival Analysis Ventricular Dysfunction, Left / physiopathology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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