Long-term results of medicamentous therapy alone in patients with dilated cardiomyopathy complicated by severe mitral insufficiency
DOI:
https://doi.org/10.14739/2310-1210.2020.6.218314Keywords:
dilated cardiomyopathy, mitral valve insufficiency, long-term clinical outcome, treatment outcomeAbstract
The aim of this study was to assess survival rates and clinical outcomes in patients with dilated cardiomyopathy (DCM) and severe functional mitral regurgitation (FMR), treated with optimal guideline-directed medical therapy (GDMT).
Materials and methods. After signing an informed consent, 84 patients with DCM and severe FMR were enrolled in the study. Concomitant tricuspid valve regurgitation was recorded in 82 (97.6 %) cases. The median NT-proBNP level was 2530 pg/ml (2123–3000 pg/ml).
Results. Hospital mortality was 5 (6.0 %) cases. Heart transplantation was performed in 4 (5.1 %) patients; therefore long-term results were analyzed in 75 patients. During the mean follow-up period of 45.9 ± 17.6 months, the occurrence of lethal outcomes (all-cause death) was 60.0 %. The 1-, 3-, and 5-year actuarial survival rate was 84.0 %, 53.3 % and 40.0 %, respectively. Left ventricular ejection fraction and systolic pressure in the pulmonary artery were independently associated with long-term all-cause mortality.
Conclusions. The study results demonstrate that the short-term and long-term mortality rates in patients with dilated cardiomyopathy and severe functional mitral regurgitation remain high despite the treatment with currently accepted pharmacological therapy. One possible method which would improve the treatment results is mitral valve surgery.
References
Bakalakos, A., Ritsatos, K., & Anastasakis, A. (2018). Current perspectives on the diagnosis and management of dilated cardiomyopathy Beyond heart failure: a Cardiomyopathy Clinic Doctor's point of view. Hellenic Journal of Cardiology, 59(5), 254-261. https://doi.org/10.1016/j.hjc.2018.05.008
Japp, A. G., Gulati, A., Cook, S. A., Cowie, M. R., & Prasad, S. K. (2016). The Diagnosis and Evaluation of Dilated Cardiomyopathy. Journal of the American College of Cardiology, 67(25), 2996-3010. https://doi.org/10.1016/j.jacc.2016.03.590
Weintraub, R. G., Semsarian, C., & Macdonald, P. (2017). Dilated cardiomyopathy. The Lancet, 390(10092), 400-414. https://doi.org/10.1016/s0140-6736(16)31713-5
Shah, N., Shah, S., Sato, K., Downey, S., Flamm, S., Tang, W. H., Cho, L., Griffin, B., & Kwon, D. (2019). Prognostic impact of functional mitral regurgitation in patients with non-ischemic cardiomyopathy: association of myocardial fibrosis and left ventricular remodeling. Journal of the American College of Cardiology, 73(9, Suppl. 1), 1456. https://doi.org/10.1016/s0735-1097(19)32062-5
Dietz, M. F., Prihadi, E. A., van der Bijl, P., Ajmone Marsan, N., Delgado, V., & Bax, J. J. (2020). Prognostic Implications of Staging Right Heart Failure in Patients With Significant Secondary Tricuspid Regurgitation. JACC: Heart failure, 8(8), 627-636. https://doi.org/10.1016/j.jchf.2020.02.008
Goel, S. S., Bajaj, N., Aggarwal, B., Gupta, S., Poddar, K. L., Ige, M., Bdair, H., Anabtawi, A., Rahim, S., Whitlow, P. L., Tuzcu, E. M., Griffin, B. P., Stewart, W. J., Gillinov, M., Blackstone, E. H., Smedira, N. G., Oliveira, G. H., Barzilai, B., Menon, V., & Kapadia, S. R. (2014). Prevalence and Outcomes of Unoperated Patients With Severe Symptomatic Mitral Regurgitation and Heart Failure: Comprehensive Analysis to Determine the Potential Role of MitraClip for This Unmet Need. Journal of the American College of Cardiology, 63(2), 185-186. https://doi.org/10.1016/j.jacc.2013.08.723
Wada, Y., Ohara, T., Funada, A., Hasegawa, T., Sugano, Y., Kanzaki, H., Yokoyama, H., Yasuda, S., Ogawa, H., & Anzai, T. (2016). Prognostic Impact of Functional Mitral Regurgitation in Patients Admitted With Acute Decompensated Heart Failure. Circulation Journal, 80(1), 139-147. https://doi.org/10.1253/circj.CJ-15-0663
Chung, H., Amaki, M., Takashio, S., Takahama, H., Ohara, T., Hasegawa, T., Sugano, Y., Fujita, T., Kobayashi, J., Asakura, M., Kanzaki, H., Anzai, T., & Kitakaze, M. (2018). Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation. Circulation Journal, 82(1), 131-140. https://doi.org/10.1253/circj.CJ-17-0104
Wang, N., Fulcher, J., Abeysuriya, N., McGrady, M., Wilcox, I., Celermajer, D., & Lal, S. (2019). Tricuspid regurgitation is associated with increased mortality independent of pulmonary pressures and right heart failure: a systematic review and meta-analysis. European Heart Journal, 40(5), 476-484. https://doi.org/10.1093/eurheartj/ehy641
Grayburn, P. A., Appleton, C. P., DeMaria, A. N., Greenberg, B., Lowes, B., Oh, J., Plehn, J. F., Rahko, P., St John Sutton, M., Eichhorn, E. J., & BEST Trial Echocardiographic Substudy Investigators. (2005). Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: the Beta-blocker Evaluation of Survival Trial (BEST). Journal of the American College of Cardiology, 45(7), 1064-1071. https://doi.org/10.1016/j.jacc.2004.12.069
Al-Amri, H. S., Al-Moghairi, A. M., & El Oakley, R. M. (2011). Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy. Journal of the Saudi Heart Association, 23(3), 125-134. https://doi.org/10.1016/j.jsha.2011.04.00
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
