The Hemodynamic and Prognostic Significance of Echo-Doppler-Proven Mitral Regurgitation in Patients with Dilated Cardiomyopathy

Abstract

Data from cardiac catheterization at rest and during exercise in 57 patients with dilated cardiomyopathy (DCM) were analyzed to evaluate the bearing of mitral regurgiation (MR) detected by color Doppler echocardiography (CDE) on prognostically important invasive hemodynamic parameters and survival. The etiology of DCM was coronary artery disease in 21 patients and unproven (‘idiopathic’) in 36 patients. MR was detected by CDE in 34 patients (60%) with an agreement of 93% compared to left ventriculography. Mean age, etiology of DCM and duration of symptoms were similar in patients with and without MR, while patients with MR were in a higher NYHA class, had lower ejection fraction (LVEF) (25 ± 13 vs. 35 ± 17%; p < 0.02), larger left ventricular volumes (356 ± 138 vs. 268 ± 61 ml; p < 0.01) and higher left ventricular end-diastolic pressure (LVEDP) (21 ± 9 vs. 13 ± 7 mm Hg; p < 0.01). At rest, right-sided pressures were higher in patients with MR compared to patients without MR (pulmonary wedge pressure 20 ± 9 vs. 10 ± 3 mm Hg, mean pulmonary arterial pressure 30 ± 11 vs. 20 ± 8 mm Hg, mean right atrial pressure 9 ± 4 vs. 4 ± 2 mm Hg, all p < 0.001), but no significant differences were found in cardiac index (CI) or stroke index (SI). During supine bicycle exercise (increasing heart rate by 50%), both groups demonstrated a similar rise in right-sided pressures, while the patients with MR exhibited a lower increase in CI (3.5 ± 1.8 vs. 4.4 ± 1.41iters/min/m²;p < 0.05) and were unable to increase SI. When survival after 1 year was analyzed as a ‘worst-case situation’ (cardiac transplantation equals death), survival was significantly lower in patients with MR (14/34 vs. 1/23; p < 0.01). CDE is a noninvasive and accurate method for detection of MR; it is valuable for early risk stratification, being a marker of the subset of patients with DCM having reduced ventricular function and a poor prognosis.

Usefulness of exercise tissue doppler echocardiography for prognostic stratification of congestive heart failure patients with left ventricular systolic dysfunction

“…It should enable selection of prognostic poor patients with acceptable sensitivity, on the other hand using of three objective parameters together contributes to the presumption of a good selection specificity. Similar to other authors we observed a difference between the patients of the two groups characterized by the tissue Doppler parameters of left ventricle longitudinal function during rest and after exercise, by the ratio E/Em, indexed left ventricle volume and the level of mitral regurgitation 5,11,[27][28][29] . In both of our models the only independent echocardiographic predictor of a poor prognosis, similarly to other published data 5,11 , was the parameter E/Em (during rest or after exercise).…”

Prognostic Significance of Non-Dilated Left Ventricular Size and Mitral Regurgitation in Patients With Dilated Phase of Hypertrophic Cardiomyopathy

“…[13][14][15][16] Chronic MR leads to progressive heart failure status through a vicious circle of LV dilatation leading to MR leading to further LV dilatation. In addition to the mechanical process, neurohormonal overload is thought to hasten the deaths of these patients.…”

“…12) Furthermore, patients with heart failure and LV dilatation often have functional mitral regurgitation (MR), and the presence of MR is also known to be associated with a poor clinical outcome. [13][14][15][16] Although patients with D-HCM have been reported to show diverse clinical expression, there is little information on the relations among LV size, presence of significant MR, and prognosis. This study was performed to determine whether echocardiographic assessment of LV size and MR provides incremental prognostic information for patients with D-HCM.…”

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

“…FMR is associated with decreased survival in patients with left ventricular systolic dysfunction and the mortality increases in parallel with the severity of FMR (1)(2)(3)(4). A number of mechanisms play role in the development of FMR.…”