***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims Significant efforts are currently undertaken to reduce functional mitral regurgitation ( FMR ) in patients with chronic heart failure in the hope to improve prognosis . We aim ed to assess the prognostic impact of FMR in heart failure with reduced ejection fraction ( HFrEF ) under optimal medical therapy ( OMT ) and various conditions of HFrEF . We further intended to identify a heart failure phenotype , where FMR is most likely a driving force and not a mere byst and er of the disease . Methods and results We prospect ively included 576 consecutive HFrEF patients into our long-term observational study . Functional [ i.e. New York Heart Association ( NYHA ) class ] , echocardiographic , invasive haemodynamic , and biochemical ( i.e. NT-proBNP , MR-proANP , MR-proADM , CT-proET-1 , copeptin ) measurements  were performed at baseline . During a median follow-up of 62 months ( interquartile range 52 - 76 ) , 47 % of patients died . Severe FMR was a significant predictor of mortality [ hazard ratio ( HR ) 1.76 , 95 % confidence interval ( CI ) 1.34 - 2.30 ; P < 0.001 ] , independent of clinical ( adjusted HR 1.61 , 95 % CI 1.22 - 2.12 ; P = 0.001 ) , and echocardiographic ( adjusted HR 1.46 , 95 % CI 1.09 - 1.94 ; P = 0.01 ) confounders , OMT ( adjusted HR 1.81 , 95 % CI 1.25 - 2.63 ; P = 0.002 ) , and neurohumoral activation ( adjusted HR 1.38 , 95 % CI 1.03 - 1.84 ; P = 0.03 ) . Sub analysis revealed that severe FMR was associated with poor outcome in an intermediate-failure phenotype of HFrEF i.e. patients with NYHA class II ( adjusted HR 2.17 , 95 % CI 1.07 - 4.44 ; P = 0.03 ) and III ( adjusted HR 1.80 , 95 % CI 1.17 - 2.77 ; P = 0.008 ) , moderately reduced left ventricular function ( adjusted HR 2.37 , 95 % CI 1.36 - 4.12 ; P = 0.002 ) , and within the second quartile ( 871 - 2360 pg/mL ) of NT-proBNP ( adjusted HR 2.16 , 95 % CI 1.22 - 3.86 ; P = 0.009 ) . Conclusion In a patient cohort under OMT , the adverse prognostic impact of FMR is given predominantly in a sub-cohort of a specific intermediate-failure phenotype-well-defined functionally , haemodynamically , biochemically , and morphologically BACKGROUND Ischemic mitral regurgitation is associated with a substantial risk of death . Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited . METHODS We r and omly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety . The primary end point was the left ventricular end-systolic volume index ( LVESVI ) at 12 months , as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank . RESULTS At 12 months , the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group ( mean change from baseline , -6.6 and -6.8 ml per square meter , respectively ) . The rate of death was 14.3 % in the repair group and 17.6 % in the replacement group ( hazard ratio with repair , 0.79 ; 95 % confidence interval , 0.42 to 1.47 ; P=0.45 by the log-rank test ) . There was no significant between-group difference in LVESVI after adjustment for death ( z score , 1.33 ; P=0.18 ) . The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group ( 32.6 % vs. 2.3 % , P<0.001 ) . There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events , in functional status , or in quality of life at 12 months . CONCLUSIONS We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair  and those who underwent mitral-valve replacement . Replacement provided a more durable correction of mitral regurgitation , but there was no significant between-group difference in clinical outcomes . ( Funded by the National Institutes of Health and the Canadian Institutes of Health ; Clinical Trials.gov number , NCT00807040 . ) BACKGROUND Mitral insufficiency is known to occur in a substantial proportion of patients with heart failure . Its relationship with morbidity and mortality is poorly described . METHODS The mortality and hospitalization for heart failure were retrospectively examined in patients who underwent baseline echocardiography in the Studies Of Left Ventricular Dysfunction ( SOLVD ) treatment and prevention trials . The presence and grade of mitral insufficiency was assessed , and patients with and without mitral insufficiency were compared . RESULTS Patients with left ventricular dysfunction and mitral insufficiency had greater than twofold increased risk of death or admission for heart failure over two years ( RR 2.38 , 95 % CI 1.43 to 3.97 ) . This excess risk persisted after adjustment for the severity of heart failure , etiology and differences in treatment ( RR 1.82 , 95 % CI 1.04 to 3.17 ; P=0.04 ) . The presence of moderate mitral insufficiency versus no insufficiency was associated with even greater independent risk ( RR 2.20 , 95 % CI 1.01 to 4.80 ; P=0.05 ) . Results were consistent with binary and ordinal analysis of mitral insufficiency . CONCLUSION The presence of mitral insufficiency in patients with left ventricular dysfunction is independently associated with adverse outcomes , including death and hospitalization for heart failure . This has potentially important clinical implication s for the assessment and management of patients with heart failure 
    Output:
    
Conclusions In comparison with OMT , PMVR significantly reduces 1-year mortality , 2-year mortality , and cardiovascular mortality in patients with HF and severe MR