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Mitral Valve Regurgitation and CHF Mortality

Mitral valve regurgitation (MR) in people with left heart
weakness and CHF predicts a worse outcome, says this study.
Compared to people with no MR, any amount of MR indicated
higher risk of death - the worse the MR, the worse the risk.
	Dr. Benjamin Trichon was lead author, "The major
finding of our study was that among people with LV systolic
dysfunction, MR is common. The other major conclusion is that
MR is an independent predictor of outcome (death) and that's
certainly something that had never been studied in a large
group before." Heart enlargement can cause MR.
	The Duke group examined the histories, coronary anatomy,
and seriousness of MR in all patients with CHF who had EFs less
than 40%, who were admitted for heart cath over a 14-year
period.
	Out of 2057 patients, 56% had MR. Of these, 70% had
mild MR (grade 1+ to 2+) and 30% had it worse (grade 3+ to 4+).
When MR as it was first measured was related to one-year, 3-
year, and 5-year survival, MR independently predicted mortality,
even after controlling for other factors.
	Survival rates were worst in the patients with moderate
or severe MR, but any degree of MR predicted mortality, with
risk 1.23 times higher in CHFers with MR. The cause of CHF did
not seem to affect how severe MR was. "The risk associated with
MR was the same in patients with or without ischemia," wrote
the researchers.
	This study shows that even mild valve regurgitation is
an independent predictor of higher risk for death. MR was still
a predictor of outcome, independent of age and cause of CHF.
	Beta-blocker use and high-dose ACE inhibitor use reduces
MR in the long term according to Trichon, but no large studies
have focused on whether CHF therapies help MR enough by
themselves.

Title:   Relation of frequency and severity of mitral
         regurgitation to survival among patients with left
         ventricular systolic dysfunction and heart failure.
Authors: Trichon BH, Felker GM, Shaw LK, Cabell CH, O'Connor
         CM.
Source:  Am J Cardiol 2003 Mar 1; 91(5):538-43.