Key result
Atrial functional MR is linked to ~2.5-fold higher mortality in HFpEF patients on hemodialysis.
Why the study?
Atrial functional mitral regurgitation is common in patients with HFpEF and ESRD undergoing hemodialysis, but its prognostic value and diagnostic biomarkers remain unclear.
Does the presence of atrial functional mitral regurgitation (AFMR) increase all-cause mortality and cardiac function deterioration in patients with HFpEF and end-stage renal disease?
Cohort (n=452)
No
Does the presence of atrial functional mitral regurgitation (AFMR) increase all-cause mortality and cardiac function deterioration in patients with HFpEF and end-stage renal disease?
Hazard Ratio: 2.456 (95% CI 1.257–4.796)
Absolute Event Rate: 25.6% vs 12.3%
p-value: p=0.009
In patients with HFpEF and ESRD on hemodialysis, the presence of atrial functional mitral regurgitation is an independent predictor of all-cause mortality and worsening cardiac function, and may be diagnosed using elevated plasma ANP levels.
AFMR was associated with higher mortality in HFpEF/ESRD on hemodialysis; leaves open whether screening or intervention alters outcomes.
Background Atrial functional mitral regurgitation (AFMR) is common in patients with heart failure with preserved ejection fraction (HFpEF) and end-stage renal disease (ESRD) undergoing hemodialysis, but its prognostic value and potential diagnostic biomarkers remain unclear. Methods We conducted a retrospective cohort study involving 452 patients with HFpEF and ESRD undergoing maintenance hemodialysis between August 2018 and September 2023. Clinical outcomes were analyzed using Kaplan–Meier curves and Cox regression. Additionally, 101 patients were prospectively recruited to explore the diagnostic value of plasma atrial natriuretic peptide (ANP) levels for AFMR using ROC analysis. Results AFMR was associated with significantly higher all-cause mortality (25.6% vs. 12.3%, P = 0.0070). Multivariate Cox regression confirmed AFMR as an independent predictor of all-cause mortality (HR: 2.456; P = 0.0090). Even mild AFMR was associated with a higher risk of all-cause mortality (HR: 2.155; P = 0.0150). Moderate-severe AFMR was significantly related to a higher incidence of cardiac function deterioration, not only compared with the non-AFMR group (HR: 4.041; 95% CI: 1.186–13.763; P = 0.026), but also compared with the mild AFMR group (HR: 3.622; 95% CI: 1.187–11.050; P = 0.024). Moreover, ANP levels were significantly elevated in the AFMR group compared to non-AFMR, which could be a significant predictor of AFMR (AUC = 0.73). Conclusion AFMR is associated with higher all-cause mortality and worsening cardiac function in patients with HFpEF and ESRD undergoing hemodialysis. ANP may serve as a potential biomarker for diagnosis of AFMR in this patient population. These results underscore the importance of early detection and management of AFMR in this high-risk population.
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Wang et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) and end-stage renal disease (ESRD) (n=452). Atrial functional mitral regurgitation (AFMR) vs. No atrial functional mitral regurgitation (non-AFMR) was evaluated on All-cause mortality (HR 2.456, 95% CI 1.257-4.796, p=0.009). Atrial functional mitral regurgitation was independently associated with a significantly higher risk of all-cause mortality (HR 2.456) in patients with HFpEF and ESRD undergoing hemodialysis.
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