PMID- 15278390
OWN - NLM
STAT- MEDLINE
DCOM- 20041222
LR  - 20040727
IS  - 0910-8327 (Print)
IS  - 0910-8327 (Linking)
VI  - 19
IP  - 4
DP  - 2004 Jul
TI  - Impact of mitral regurgitation on long-term survival in patients with ischemic 
      cardiomyopathy: efficacy of combined mitral valve repair and revascularization.
PG  - 172-8
AB  - Ischemic cardiomyopathy complicated by severe mitral regurgitation (MR) has a 
      poor prognosis. In such cases, whether mitral valve repair for MR improves the 
      prognosis of survival remains unclear. In this study, 50 patients diagnosed with 
      ischemic cardiomyopathy at our hospital between August 1991 and August 1996 were 
      studied to examine the long-term prognosis and factors determining the prognosis. 
      Among 17 patients with the complication of severe MR, 11 underwent mitral valve 
      repair (repair group) and 6 did not (nonrepair group). Among the 33 patients 
      without MR, 15 underwent revascularization (revascularization group) and 18 
      received medical treatment alone (medical group). Patients with MR showed 
      significantly poorer baseline activities of daily living (ADL) [New York Heart 
      Association (NYHA) class III or above: MR(+) vs MR(-) = 14 vs 8; P = 0.0001] and 
      survival rate [MR(+) vs MR(-); log rank = 3.8, P = 0.05]. In contrast, patients 
      in whom mitral valve repair was actively performed to resolve MR had favorable 
      outcomes for both ADL (NYHA class improved from 3.9 +/- 0.3 to 2.7 +/- 1.0; P = 
      0.0004) and survival rate (MV repair vs nonrepair: long rank = 10.1, P = 0.0015). 
      In addition, among patients without MR, the revascularization group showed more 
      favorable results in terms of ADL (NYHA class improved from 3.5 +/- 0.7 to 2.5 
      +/- 0.8; P = 0.0059) and survival rate (revascularization vs medical: log rank = 
      3.7, P = 0.05), irrespective of improvement of left ventricular function. When 
      the factors determining the prognosis for ischemic cardiomyopathy were examined 
      by multivariate analysis, whether or not revascularization was conducted, the 
      presence or absence of mitral regurgitation, and if present, whether or not 
      mitral valve repair was performed were identified as independent factors 
      determining the prognosis (revascularization: hazard ratio = 0.121, P = 0.012; 
      absence of MR: hazard ratio = 0.104, P = 0.050; mitral valve repair: hazard ratio 
      = 0.018, P = 0.005). These results showed that revascularization should be 
      conducted as actively as possible in patients with ischemic cardiomyopathy; in 
      addition, for those patients with mitral regurgitation, mitral valve repair 
      should be conducted actively to relieve it.
FAU - Uchikawa, Shin-Ichiro
AU  - Uchikawa S
AD  - First Department of Internal Medicine, Shinshu University School of Medicine, 
      3-1-1 Asahi, 390-8621, Matsumoto, Japan. shinuchi@marunouchi.or.jp
FAU - Ohtaki, Eiji
AU  - Ohtaki E
FAU - Sumiyoshi, Tetsuya
AU  - Sumiyoshi T
FAU - Hosoda, Saichi
AU  - Hosoda S
FAU - Kasegawa, Hitoshi
AU  - Kasegawa H
LA  - eng
PT  - Journal Article
PL  - Japan
TA  - Heart Vessels
JT  - Heart and vessels
JID - 8511258
SB  - IM
MH  - Aged
MH  - Cardiomyopathy, Dilated/*complications/*mortality/surgery
MH  - *Coronary Artery Bypass
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/*complications/*surgery
MH  - Multivariate Analysis
MH  - Myocardial Ischemia/*complications/*mortality/surgery
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Time Factors
EDAT- 2004/07/28 05:00
MHDA- 2004/12/23 09:00
CRDT- 2004/07/28 05:00
PHST- 2003/06/07 00:00 [received]
PHST- 2004/01/09 00:00 [accepted]
PHST- 2004/07/28 05:00 [pubmed]
PHST- 2004/12/23 09:00 [medline]
PHST- 2004/07/28 05:00 [entrez]
AID - 10.1007/s00380-004-0763-y [doi]
PST - ppublish
SO  - Heart Vessels. 2004 Jul;19(4):172-8. doi: 10.1007/s00380-004-0763-y.