Moderate-severe mitral regurgitation at 9 months was associated with an increased risk of all-cause death or heart failure hospitalization, with an unadjusted hazard ratio of 2.03 (95% CI 1.57–2.63).
Cohort (n=1,022)
Yes
Does the presence of moderate-severe mitral regurgitation after guideline-recommended medical therapy optimization increase the risk of all-cause death or HF hospitalization in patients with heart failure?
Persistent moderate-severe mitral regurgitation after guideline-directed medical therapy optimization in heart failure is associated with a significantly increased risk of mortality and heart failure hospitalization.
Effect estimate: HR 2.03 (95% CI 1.57-2.63)
Absolute Event Rate: 18% vs 31.7%
p-value: p=<0.001
Abstract Background Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-recommended medical therapy (GRMT) in heart failure (HF). Our aim was to evaluate the evolution and impact of MR after GRMT in the Biology study to Tailored treatment in chronic heart failure (BIOSTAT-CHF). Methods A retrospective post-hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization. Results Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate-severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate-severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint (unadjusted hazard ratio HR, 2.03; 95% confidence interval CI, 1.57–2.63; p < 0.001), also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR, 1.85; 95% CI 1.43–2.39; p < 0.001). Younger age, LVEF ≥ 50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of persistence of moderate-severe MR at 9 months, whereas older age was the only predictor of worsening MR. Conclusions Among patients with HF undergoing GRMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate-severe MR after GRMT was associated with worse outcome. Graphical abstract
Pagnesi et al. (Wed,) conducted a cohort in Heart Failure (n=1,022). Guideline-recommended medical therapy optimization vs. No medical therapy optimization was evaluated on Composite of all-cause mortality or heart failure hospitalization (HR 2.03, 95% CI 1.57-2.63, p=<0.001). Moderate-severe mitral regurgitation at 9 months was associated with an increased risk of all-cause death or heart failure hospitalization, with an unadjusted hazard ratio of 2.03 (95% CI 1.57–2.63).