Severity of functional mitral regurgitation on admission predicts long-term risk of rehospitalization and death

1. The rate of all-cause mortality in acute decompensated heart failure 1 year after admission was 4.5 times higher in patients with moderate/severe functional mitral regurgitation than those without it.

2. Rates of 6-month hospitalizations were 2.5 times higher in patients with moderate/severe FMR than those without it.

Evidence Rating Level: 2 (Good)

Functional mitral regurgitation is common in chronic heart failure. It has been linked to reduced mortality and hospitalizations with the use of percutaneous transcatheter repair techniques. In acute decompensated heart failure (ADHF), functional mitral regurgitation (FMR) has been hypothesized to represent a mismatch between ventricular preload and afterload for which pharmacologic treatment is available. To date, its prognostic significance has not been recognized. This retrospective cohort study collected clinical and laboratory data of 2303 adult inpatients with ADHF and left ventricular systolic dysfunction (<50%) to assess the prevalence of FMR and its prognostic significance. Exclusion criteria included no trans-thoracic echocardiogram in the initial 72 hours of admission, normal left ventricular ejection fraction and mitral valve degeneration or ischemic mitral regurgitation. Study groups were formed according to echocardiogram results: none/mild (n=1093, 47%), moderate (n=757, 33%), and moderate/severe FMR (n=453, 20%). Primary outcomes of the study were 1-year post-discharge all-cause mortality, while secondary outcomes were heart failure hospitalization rates. Results showed that more severe FMR was linked with larger left ventricular chamber sizes (diameter at end-diastole 6.1 cm versus 5.9 cm versus 5.7 cm, p<0.001, diameter at end-systole 5.2 cm versus 5 cm versus 4.7 cm, p<0.001) and lower LVEF (25% versus 25% versus 30%, p<0.001). Relative risk for all-cause mortality in the first year after admission was higher in patients with moderate/severe FMR compared with none/mild FMR (HR 1.45, 95% CI, 1.001-2.08, p-0.049). Additionally, rates of 6-month hospitalizations were higher in moderate FMR than those with no or mild FMR (HR 1.24, 95% CI, 1.03-1.49, p=0.02) and similarly higher in those with moderate/severe FMR than those with none or mild FMR (HR 1.25, 95% CI, 1.006-1.55, p=0.043). To improve post-discharge outcomes, prompt characterization, medical optimization and close follow up of acute heart failure patients with FMR should be considered.

Click to read the study in JAHA

Image: PD

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