PMID- 20485237
OWN - NLM
STAT- MEDLINE
DCOM- 20101223
LR  - 20100520
IS  - 0026-4725 (Print)
IS  - 0026-4725 (Linking)
VI  - 58
IP  - 3
DP  - 2010 Jun
TI  - The risk of worsening CHF is positively related to unitary increase in mitral 
      regurgitation size: a case-cohort study derived from a II NYHA class CHF patient 
      population.
PG  - 301-12
AB  - AIM: The passage from II to III New York Heart Association (NYHA) class is 
      indicative of cardiopulmonary impairment and unfavourable prognosis. Among 
      chronic heart failure(CHF) II NYHA class patients, the topic has been debated 
      what criteria have be assumed for identifying the patients prone to accelerated 
      progression towards III NYHA class. METHODS: A case cohort study, including a 
      number of CHF II NYHA class patients, was carried out, to evaluate the role as 
      predictor of CHF worsening of some ultrasonographic parameters, listed as 
      follows: left ventricular ejection fraction, as continuous and as a dichotomous 
      variable, i.e. subdivided as follows: 1) LVEF larger than 40% and 2) LVEF ranged 
      from 30% to 40%; mitral regurgitation (MR), as continuous and as a dichotomic 
      variable (i.e. moderate-to-severe MR, defined by transmitralic jet planimetric 
      area estimated as larger than 20% of left atrium area), restrictive LV filling 
      pattern and pulmonary systolic arterial pressure >40 mmHg. The pts were 
      subdivided in 3 categories, as follows:1) diastolic CHF, i.e. heart failure with 
      normal or only mildly impaired left ventricular ejection fraction - 20 patients; 
      2) systolic CHF, i.e. heart failure with reduced left ventricular ejection 
      fraction - 19 patients; and 3) CHF due to "organic" mitral insufficiency-19 
      patients. All patients were treated with pharmacologic therapy, according to 
      their respective clinical features and typology of basal heart disease. The 
      sensitivity, specificity, positive predictive value (PPV), negative predictive 
      value (NPV) for the composite endpoint death and hospitalization due to worsening 
      CHF were investigated, concerning each of the above-mentioned criteria. Moreover, 
      the odds ratios (OR) were calculated, by not conditional logistic regression 
      analysis, to achieve information about risk of death and/or worsening CHF, as 
      well as the respective profiles of risk, assessed by relative risk (RR). RESULTS: 
      From 173 followed-up patients, 58 patients,70+/-12 aged, whose 15 cases 
      (transition to III NYHA class) and 43 controls, were included in retrospective 
      analysis. Notewhorty, moderate-to-severe MR only seemed to play a role as 
      reliable predictor of worsening CHF(sensitivity: 93.3%; specificity: 69.7%; PPV: 
      51.8%; NPV: 96.7%; RR:15.93; OR: 32.3), as its sensitivity and PPV, particularly, 
      were shown to exceed far and away the values of sensitivity and PPV associated to 
      each of other echographic and/or clinical variables. Nevertheless, at 
      multivariate analysis,MR expressed as continuous variable only, but not as 
      "categorical" variable-was demonstrated to independently predict the transition 
      from II to III NYHA class, over two years clinical follow up. CONCLUSION: The 
      present data seem to support the view that the larger regurgitant jet of mitral 
      insufficiency, the higher the risk of worsening CHF during a two years follow up. 
      Likewise, it is plausible the moderate-severe MR represents a predictor of 
      increased risk of transition to III NYHA class among the CHF II NYHA class 
      patients. In addition, this study seems to indicate that a surgical therapy 
      (prosthetic replacement or mitral valvuloplasty)should always be planned in the 
      case of II NYHA class CHF patient who has been recognized affected by 
      moderate-to-severe MR, since the chances of successful pharmacological prevention 
      of clinical impairment in this setting turned out to be very slight.
FAU - De Vecchis, R
AU  - De Vecchis R
AD  - Cardiology Unit, Presidio Sanitario Intermedio Elena d'Aosta, Naples, Italy. 
      r.de.vecchis@alice.it
FAU - Cioppa, C
AU  - Cioppa C
FAU - Giasi, A
AU  - Giasi A
FAU - Pucciarelli, A
AU  - Pucciarelli A
FAU - Ariano, C
AU  - Ariano C
FAU - Pucciarelli, G
AU  - Pucciarelli G
FAU - Cantatrione, S
AU  - Cantatrione S
LA  - eng
PT  - Journal Article
DEP - 20100205
PL  - Italy
TA  - Minerva Cardioangiol
JT  - Minerva cardioangiologica
JID - 0400725
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/classification/*complications
MH  - Humans
MH  - Male
MH  - Mitral Valve Insufficiency/*complications/pathology
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
EDAT- 2010/05/21 06:00
MHDA- 2010/12/25 06:00
CRDT- 2010/05/21 06:00
PHST- 2010/05/21 06:00 [entrez]
PHST- 2010/05/21 06:00 [pubmed]
PHST- 2010/12/25 06:00 [medline]
AID - R05102871 [pii]
PST - ppublish
SO  - Minerva Cardioangiol. 2010 Jun;58(3):301-12. Epub 2010 Feb 5.