PMID- 29020337
OWN - NLM
STAT- MEDLINE
DCOM- 20191007
LR  - 20191007
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 39
IP  - 1
DP  - 2018 Jan 1
TI  - Refining the prognostic impact of functional mitral regurgitation in chronic 
      heart failure.
PG  - 39-46
LID - 10.1093/eurheartj/ehx402 [doi]
AB  - AIMS: Significant efforts are currently undertaken to reduce functional mitral 
      regurgitation (FMR) in patients with chronic heart failure in the hope to improve 
      prognosis. We aimed to assess the prognostic impact of FMR in heart failure with 
      reduced ejection fraction (HFrEF) under optimal medical therapy (OMT) and various 
      conditions of HFrEF. We further intended to identify a heart failure phenotype, 
      where FMR is most likely a driving force and not a mere bystander of the disease. 
      METHODS AND RESULTS: We prospectively included 576 consecutive HFrEF patients 
      into our long-term observational study. Functional [i.e. New York Heart 
      Association (NYHA) class], echocardiographic, invasive haemodynamic, and 
      biochemical (i.e. NT-proBNP, MR-proANP, MR-proADM, CT-proET-1, copeptin) 
      measurements were performed at baseline. During a median follow-up of 62 months 
      (interquartile range 52-76), 47% of patients died. Severe FMR was a significant 
      predictor of mortality [hazard ratio (HR) 1.76, 95% confidence interval (CI) 
      1.34-2.30; P < 0.001], independent of clinical (adjusted HR 1.61, 95% CI 
      1.22-2.12; P = 0.001), and echocardiographic (adjusted HR 1.46, 95% CI 1.09-1.94; 
      P = 0.01) confounders, OMT (adjusted HR 1.81, 95% CI 1.25-2.63; P = 0.002), and 
      neurohumoral activation (adjusted HR 1.38, 95% CI 1.03-1.84; P = 0.03). 
      Subanalysis revealed that severe FMR was associated with poor outcome in an 
      intermediate-failure phenotype of HFrEF i.e. patients with NYHA class II 
      (adjusted HR 2.17, 95% CI 1.07-4.44; P = 0.03) and III (adjusted HR 1.80, 95% CI 
      1.17-2.77; P = 0.008), moderately reduced left ventricular function (adjusted HR 
      2.37, 95% CI 1.36-4.12; P = 0.002), and within the second quartile 
      (871-2360 pg/mL) of NT-proBNP (adjusted HR 2.16, 95% CI 1.22-3.86; P = 0.009). 
      CONCLUSION: In a patient cohort under OMT, the adverse prognostic impact of FMR 
      is given predominantly in a sub-cohort of a specific intermediate-failure 
      phenotype-well-defined functionally, haemodynamically, biochemically, and 
      morphologically.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author 2017. For permissions, please email: journals.permissions@oup.com.
FAU - Goliasch, Georg
AU  - Goliasch G
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Bartko, Philipp E
AU  - Bartko PE
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Pavo, Noemi
AU  - Pavo N
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Neuhold, Stephanie
AU  - Neuhold S
AD  - Department of Medicine IV, Kaiser Franz Josef Spital, Kundratstrasse 3, 1100 Wien, 
      Vienna, Austira.
FAU - Wurm, Raphael
AU  - Wurm R
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Mascherbauer, Julia
AU  - Mascherbauer J
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Lang, Irene M
AU  - Lang IM
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
FAU - Strunk, Guido
AU  - Strunk G
AD  - FH Campus Wien and Complexity Research, Favoritenstrasse 226, 1100 Wien, Vienna, 
      Austria.
FAU - Hulsmann, Martin
AU  - Hulsmann M
AD  - Department of Internal Medicine II, Medical University of Vienna, Waehringer 
      Guertel 18-20, A-1090 Vienna, Austria.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
MH  - Aged
MH  - Chronic Disease
MH  - Female
MH  - *Heart Failure/complications/epidemiology/physiopathology/therapy
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Mitral Valve Insufficiency/complications/epidemiology/physiopathology
MH  - Prognosis
MH  - Stroke Volume/physiology
OTO - NOTNLM
OT  - Functional mitral regurgitation
OT  - HFrEF
OT  - Prognosis
EDAT- 2017/10/12 06:00
MHDA- 2019/10/08 06:00
CRDT- 2017/10/12 06:00
PHST- 2017/02/07 00:00 [received]
PHST- 2017/06/27 00:00 [accepted]
PHST- 2017/10/12 06:00 [pubmed]
PHST- 2019/10/08 06:00 [medline]
PHST- 2017/10/12 06:00 [entrez]
AID - 4035734 [pii]
AID - 10.1093/eurheartj/ehx402 [doi]
PST - ppublish
SO  - Eur Heart J. 2018 Jan 1;39(1):39-46. doi: 10.1093/eurheartj/ehx402.