Key result
Moderate or greater mitral regurgitation increased 5-year death or heart failure risk from 13.9% to 34.2% in nonobstructive/midventricular/apical HCM but not in HOCM or ES-HCM.
Why the study?
Data on the long-term prognostic impact of mitral regurgitation and its progression or regression over time remain limited across individual hypertrophic cardiomyopathy subtypes.
Does moderate or greater mitral regurgitation worsen the composite of all-cause death or heart failure hospitalization across different subtypes of hypertrophic cardiomyopathy?
Does moderate or greater mitral regurgitation worsen the composite of all-cause death or heart failure hospitalization across different subtypes of hypertrophic cardiomyopathy?
Answers are grounded in this paper and cite their sources.
Moderate or greater mitral regurgitation is associated with worse clinical outcomes in nonobstructive and other HCM subtypes, but not in hypertrophic obstructive or end-stage HCM, highlighting the need for subtype-specific management strategies.
BACKGROUND: Mitral regurgitation (MR) is a frequent comorbidity in patients with hypertrophic cardiomyopathy (HCM), which includes distinct subtypes with various characteristics. However, data on the long-term prognostic impact of MR and its progression or regression over time remain limited, particularly across individual HCM subtypes. METHODS: Patients with HCM were retrospectively included from a Japanese multicenter registry and compared by MR severity (moderate or greater versus mild or less) within each subtype: hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM (including nonobstructive, midventricular obstruction, and apical HCM). RESULTS: Among 3602 patients (HOCM: n=837; ES-HCM: n=275; other HCM: n=2490), the prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%). During a median follow-up of 5.3 (interquartile range, 2.1–9.3) years, the cumulative 5-year incidence of all-cause death or heart failure hospitalization was not significantly different between the moderate or greater MR and mild or less MR groups in HOCM (14.6% versus 12.4%; P =0.35) or ES-HCM (60.7% versus 54.7%; P =0.84). After adjustment for clinical covariates, no significant association was observed in either subtype (HOCM: hazard ratio, 1.13 [95% CI, 0.79–1.60], P =0.51; ES-HCM: hazard ratio, 0.84 [95% CI, 0.55–1.28], P =0.42). In contrast, in other HCM, moderate or greater MR was significantly associated with the higher 5-year cumulative incidence of all-cause death or heart failure hospitalization (34.2% versus 13.9%, P <0.001), which remained significant after adjustment, with a significant interaction (hazard ratio, 1.45 [95% CI, 1.09–1.91], P =0.01; P interaction =0.02). MR severity improved over time in HOCM, showed no clear change in ES-HCM, and worsened in other HCM ( P <0.001, 0.46, and <0.001, respectively; P interaction <0.001). CONCLUSIONS: In patients with HCM, moderate or greater MR was not associated with worse outcomes in HOCM or ES-HCM, but had significant prognostic implications in other HCM subtypes, suggesting the need for HCM subtype-specific MR management.
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Obayashi et al. (2026) studied this question. Moderate or greater mitral regurgitation increased 5-year death or heart failure risk from 13.9% to 34.2% in nonobstructive/midventricular/apical HCM but not in HOCM or ES-HCM.
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