Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography

Abstract

A number of parameters recorded during dobutamine stress echocardiography (DSE) are associated with worse outcome. However, the relative importance of baseline mitral regurgitation (MR) is unknown. The aim of this study was to assess the prevalence and associated implications of functional MR with long-term mortality in a large cohort of patients referred for DSE. 6745 patients (mean age 64.9 ± 12.2 years) were studied. Demographic, baseline and peak DSE data were collected. All-cause mortality was retrospectively analyzed. DSE was successfully completed in all patients with no adverse outcomes. MR was present in 1019 (15.1%) patients. During a mean follow up of 5.1 ± 1.8 years, 1642 (24.3%) patients died and MR was significantly associated with increased all-cause mortality (p < 0.001). With Kaplan–Meier analysis, survival was significantly worse for patients with moderate and severe MR (p < 0.001). With multivariate Cox regression analysis, moderate and severe MR (HR 2.78; 95% CI 2.17–3.57 and HR 3.62; 95% CI 2.89–4.53, respectively) were independently associated with all-cause mortality. The addition of MR to C statistic models significantly improved discrimination. MR is associated with all-cause mortality and adds incremental prognostic information among patients referred for DSE. The presence of MR should be taken into account when evaluating the prognostic significance of DSE results.

Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

“…On the other hand, mitral valve regurgitation has been identified as an important long-term predictor of adverse outcomes in patients with ischaemic heart disease in different clinical scenarios, such as after acute myocardial infarction[43], coronary artery bypass graft surgery[44], percutaneous coronary intervention[45] and even stable CAD[46]. Recently, it has also been associated with a worse prognosis in patients referred for non-invasive stress testing (dobutamine stress echocardiography)[47].…”

Cardiac structure and function after revascularization versus medical therapy for renal artery stenosis: the ASTRAL heart echocardiographic sub-study

“…All image acquisitions and measurements were performed as recommended by the American Society of Echocardiography [14] and have been described previously [15]. In brief, left ventricular end diastolic diameter (LVEDD), LV end systolic diameter (LVESD), interventricular and LV posterior wall thickness at end diastole were measured from parasternal long-axis M mode recordings of the LV.…”