ABSTRACT

Functional mitral regurgitation (MR) contributes significantly to the poor hemodynamic status of patients with advanced systolic heart failure. Its presence is an unfavorable prognostic marker in patients with systolic heart failure and is associated with worsening clinical symptoms, a decrease in exercise capacity, and decreased survival. In a prospective trial including 128 consecutive patients with left ventricular (LV) dysfunction (LV ejection fraction (LVEF) <50%, average 31% ± 9%), more than 80% of all patients presented with more than trace functional MR.1

Another study reported a 30% incidence of severe MR in patients with severely depressed LV function.2 The severity of functional MR has been associated with an adverse outcome in terms of mortality and hospitalization,2-5 particularly in patients after myocardial infarction.6

This motivated the development of numerous different therapeutic strategies to reduce the severity of functional MR, ranging from pharmacologic treatment7 to corrective surgical measures8 and more recently percutaneous approaches for mitral annuloplasty.9 Conservative medical treatment with vasodilator agents such as angiotensin-converting enzyme (ACE) inhibitors is of limited success, with a 2-year survival rate of less than 60% in patients with