February 21, 2026European Journal of Heart Failure0 citations
View Full PaperImpact of contemporary guideline-directed medical therapy on secondary mitral and tricuspid regurgitation in heart failure with reduced ejection fraction
Key Result
In HFrEF patients on contemporary GDMT, 75% with ≥moderate MR or TR regressed to mild/no regurgitation over ~7 months, while 5-6% without baseline regurgitation developed ≥moderate MR/TR.
Key Points
- To evaluate the regression and development rates of secondary mitral and tricuspid regurgitation in heart failure patients receiving guideline-directed medical therapy.
- Identified patients with heart failure recently diagnosed and enrolled in GDMT titration program from 2019 to 2024.
- Calculated rates of regression from moderate to mild mitral and tricuspid regurgitation.
- Evaluated the development of new moderate regurgitation in patients without baseline issues over time.
- 28% had moderate mitral regurgitation and 14% had moderate tricuspid regurgitation at baseline.
- 75% of patients with moderate mitral regurgitation experienced regression to none or mild.
- 75% of patients with moderate tricuspid regurgitation also regressed to none or mild.
- Only 5% and 6% of patients without significant baseline regurgitation developed moderate mitral and tricuspid regurgitation, respectively.
Structured PICO
Does contemporary guideline-directed medical therapy improve secondary mitral and tricuspid regurgitation in patients with recently diagnosed heart failure with reduced ejection fraction?
P
Population
844 patients with <1 year diagnosis of HFrEF with mildly (40%≤EF<50%) or moderately (<40%) reduced EF enrolled in a GDMT titration program between 2019-2024, median age 64, 68% men, 24% NYHA class III/IV.
I
Intervention
Contemporary guideline-directed medical therapy (GDMT) titration
O
Outcome
Rates of regression of ≥moderate MR/TR to ≤mild and rates of development of incident ≥moderate MR/TRsurrogate
Contemporary GDMT titration is associated with high rates of regression (75%) of secondary mitral and tricuspid regurgitation in patients with recently diagnosed HFrEF.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
Abstract Background and Aims We aimed to assess regression and development rates of ≥moderate secondary MR and TR in patients with HFrEF in association with contemporary GDMT. Methods Patients with 1 year diagnosis of HFrEF with mildly (40%≤EF50%) or moderately (40%) reduced EF enrolled in GDMT titration program 2019-2024 were identified. Rates of regression of ≥moderate MR/TR to ≤mild and rates of development of incident ≥moderate MR/TR were calculated. Results Among 844 patients (median age 64; 68% men; 26% mildly reduced EF; 24% NYHA class III/IV), 28% had ≥moderate MR and 14% had ≥moderate TR at baseline. Over median 7.1 months, 171 (75%) patients with ≥moderate MR experienced regression to no/mild MR. Similarly, 87 (75%) patients with ≥moderate TR had regression to no/mild TR over the same period. In contrast, over median 13 months, incident ≥moderate MR developed in 5% of patients with no/mild baseline MR and incident ≥moderate TR developed in 6% with no/mild baseline TR. Number of GDMT medications at follow-up was less in patients who did not have MR/TR regression (vs who did) and in patients who developed MR/TR (vs who did not). On subgroup analysis, patients with NYHA class I/II received similar number of GDMT and had similar rate of MR and TR regression and development vs patients with NYHA III/IV. However, patients with mildly reduced EF received less GDMT medications vs patients with moderately reduced EF and experienced less MR regression. Conclusion In patients with a recent diagnosis of HFrEF receiving contemporary GDMT, the majority of patients with ≥moderate secondary MR and TR achieved regression of MR/TR, and the minority of patients without significant baseline MR/TR developed ≥moderate regurgitation at follow-up.