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Significant independent predictors of death for these patients with idiopathic DCM were low forward stroke volumes, with an EF of less than 25%, and MR (Stevenson et al., 1987). Other predictors are episodes of heart failure, and increased LV end-diastolic volume (Anguita et al., 1993). Most patients with DCM die from heart failure despite improvements in medical therapy. The 1-year survival was 25% in a study of medically treated patients in NYHA class IV (Rose et al., 2001). The question then is whether such patients have a worse prognosis because of the MR or because their ventricles are more intrinsically damaged to begin with. According to the updated ACC/AHA [http://www.selleck.co.jp/products/Pomalidomide(CC-4047).html selleck kinase inhibitor] guidelines for managing patients with HF (Hunt, 2005), MR is a poor prognostic sign for patients with end-stage cardiomyopathy. Yamano et al. (2008) studied patients with FMR during exercise and concluded that FMR was significantly exacerbated during exercise, which was strongly related to their exercise intolerance, thus, the clinical impact of FMR in patients with DCM could be more serious than can be expected by its degree at rest. Bursi et [http://www.selleck.co.jp/products/tenofovir-alafenamide-gs-7340.html Tenofovir solubility dmso] al. examined the independent prognostic role of FMR and its impact across the severity of CHF in a large population of outpatients with systolic HF. Four hundred and sixty-nine patients were followed-up for death and heart transplant according to severity of their FMR on baseline echocardiography. The 5-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?[https://en.wikipedia.org/wiki/Oxymatrine Oxymatrine] role in the early phase of HF and should therefore be the focus of therapeutic strategies attempting to reduce it (Bursi et al., 2010). There are several methods to reduce MR, including optimal medical therapy, treating arrhythmias, cardiac resynchronization therapy, cardiac passive, restraint or constraint devices, and MV surgery (Starling, 2007). Advances have been made with medical therapy and cardiac resynchronization but, despite such measures, outcomes remain poor in individuals with advanced HF (Rose et al., 2001). Surgical correction of MR is not performed frequently as a stand alone procedure in patients whose primary problem is a dilated failing heart (Enriquez-Sarano et al., 2008).