Functional mitral regurgitation (FMR) is associated with a poor outcome in patients
with reduced left ventricular ejection fraction (LVEF). Two recent studies of percutaneous
mitral valvular repair therapy reported disparate results, likely due in part to variable
risk among FMR patients. The aim of this study is to define echocardiographic factors
of prognostic significance in FMR patients, and particularly to compare ischemic and
nonischemic FMR. We followed three hundred sixteen consecutive patients (age 60 ±
14 years, men 70%) with FMR and LVEF ≤ 35% between January 2010 and December 2015
(mean follow-up 3.7 years). Patients were categorized into ischemic (39.6%) and nonischemic
(60.4%). MR was graded according to the American Society of Echocardiography guidelines.
Although echo findings were similar between ischemic and nonischemic patient, the
incidence of death, heart transplantation (HT), or LVAD implantation was higher in
ischemic than in nonischemic patients (Log rank p = 0.001). In age and gender adjusted
multivariate (11 variables) Cox regression analysis, left atrium volume index (LAVI)
was associated with death, HT, or LVAD with hazard ratio of 2.1 for patients with
FMR (p = 0.003). LAVI greater than 48.7 mL/m2 predicts adverse outcome in both nonischemic and ischemic FMR (AUC 0.62, p < 0.001).
Combined ischemic FMR with LAVI ≥ 48.7 mL/m2 had the highest incident rate of all groups. In conclusion, despite similar LV function
and MR severity, ischemic FMR patients had higher mortality than nonischemic patients.
Of all echocardiographic parameters, an LAVI ≥ 48.7 mL/m2 predicted adverse clinical outcome.
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Article info
Publication history
Published online: May 15, 2021
Received in revised form:
March 28,
2021
Received:
February 10,
2021
Footnotes
We thank the registered sonographers of the University of California San Diego for their effort.
Funding: None
Disclosures: None
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
