Evolución de la insuficiencia mitral severa tras optimización del tratamiento médico en la miocardiopatía dilatada no isquémica

In dilated cardiomyopathy, severe functional mitral regurgitation (MR) is associated with a poor prognosis. In 112 consecutive clinically stable patients with non-ischemic dilated cardiomyopathy, echocardiography identified 15 (14%) patients who had severe MR (age, 53 ± 12 years; 80% male; left ventricular ejection fraction, 26 ± 8%). Existing medical treatment with ACE inhibitors and betablockers was increased up to the maximum tolerated doses. At 6 months, MR decreased by at least one grade in 13 (87%) patients (P =.001), as did the effective regurgitant orifice area (from 0.41 [0.05] mm2 to 0.20 [0.15] mm2; P <.001) and the jet area (from 13.6 [2.1] cm2 to 7.4 [4.5] cm2; P <.001). These changes correlated with an increase in left ventricular ejection fraction (from 26 [8]% to 35 [10]%, P=.009; r=0.60, P=.01) and a decrease in enddiastolic volume (from 168 [46] mL to 142 [72] mL, P=.04; r=.0.59, P=.02). An improvement in New York Heart Association class was observed (from 2.7 [0.5] to 1.9 [0.7]; P<.001). The severity of functional MR decreased after medical treatment was maximized. The decrease correlated with improvements in left ventricular systolic function.