Institute of Cardiology, Policlinico University Hospital, Via del Pozzo 71, Modena, Italy.
Eur J Heart Fail. 2010 Apr;12(4):382-8. doi: 10.1093/eurjhf/hfq014. Epub 2010 Mar 2.
To examine the independent prognostic role of functional mitral regurgitation (FMR) and its impact across the severity of chronic heart failure (CHF) in a large population of outpatients with systolic CHF followed at two multidisciplinary clinics.
Echocardiography was performed upon enrolment in 469 CHF patients. Follow-up for death and heart transplant was updated on January 2007. Five-year transplant-free survival was 82.7% in patients with no or Grade I FMR, 64.4% in Grade II, 58.5% in Grade III, and 46.5% in Grade IV (P < 0.0001). There was a strong graded association between FMR and the long-term risk of death and heart transplant, which remained significant after multivariable adjustment (P = 0.0003). The association between FMR and events was strong and independent in patients with less severe symptoms and in those at lower overall risk based on a propensity score analysis, while it was not significant in patients with more advanced CHF or in the high-risk subgroup (P < 0.0001 for interactions).
This study clarifies previous apparently discrepant results by demonstrating that FMR is an independent determinant of death and heart transplantation only in less severe CHF and in patients with a lower risk profile. This finding indicates that FMR plays a major role in the early phase of CHF, suggesting that this should be the focus of strategies attempting to reduce it.
在两个多学科诊所随访的大量射血分数降低的慢性心力衰竭（HF）门诊患者中，研究功能性二尖瓣反流（FMR）的独立预后作用及其对心力衰竭严重程度的影响。
在 469 例 HF 患者入组时进行了超声心动图检查。截至 2007 年 1 月，对死亡和心脏移植进行了随访。无或 FMRⅠ级患者的 5 年无移植生存率为 82.7%，FMRⅡ级为 64.4%，FMRⅢ级为 58.5%，FMRⅣ级为 46.5%（P<0.0001）。FMR 与死亡和心脏移植的长期风险之间存在强烈的分级关联，多变量调整后仍具有统计学意义（P=0.0003）。基于倾向评分分析，在症状较轻和整体风险较低的患者中，FMR 与事件之间的关联强烈且独立，而在心力衰竭程度较重的患者或高危亚组中，这种关联不显著（交互作用 P<0.0001）。
本研究通过证实 FMR 仅在心力衰竭程度较轻和风险较低的患者中是死亡和心脏移植的独立决定因素，澄清了先前明显不一致的结果。这一发现表明 FMR 在心力衰竭的早期阶段起主要作用，提示这应该是试图降低 FMR 的策略的重点。
