Introduction: This study assessed whether patients (pts) with severe secondary mitral regurgitation (MR) and progressive heart failure (HF) profit from CRT if indicated in accordance with current guidelines.
Methods: About 26,000 transthoracic echocardiographies (TTE) and related medical reports were analysed. A combined endpoint of cardiac death and recurrent (n>=3) hospitalisation for acutely decompensated HF was chosen. Pts were followed for maximum five years (median 1179 days) and outcome of pts with and without CRT was compared. The predictive value of the TTE-critieria to indicate CRT (LVEF <= 35) was compared to other TTE-parameters.
Results: In our study population of 72 pts (48 men, median age 75 years, median EF 29%), 29,2% pts were treated with CRT. Pts with and without CRT showed an event rate of 28% and 14%, respectively. The subgroup of pts with CRT and atrial fibrillation showed an event rate of 37% (Fig. 1). LVEDD was a significant and strong predictor (Fig. 2) of patients outcome (p=0.024; HR 10.5; AUC 0.73) compared to LVEF (p=0.11, AUC 0.63) and pulmonary hypertension (p=0.612; AUC 0.54).
Conclusions: Not all patients with severe secondary MR and HF profit from CRT if indicated according to current guidelines. Patients with permanent atrial fibrillation and CRT (IIb/c recommendation) seem to have an adverse outcome. LVEDD as surrogate for progressed remodelling shows a better predictive value than LVEF and might be favourable for CRT indication and risk stratification in this selected patient collective.