In patients with heart failure and mitral regurgitation, 4.8% developed severe MR over 1.4 years; atrial fibrillation (aOR 1.52), ischaemic heart disease (aOR 1.44), hypertension (aOR 1.35), and higher LVIDD (aOR 1.36 per cm) increased risk, while beta-blockers reduced risk (aOR 0.74).
Observational (n=7,391)
Yes
In patients with heart failure, clinical factors including atrial fibrillation, ischemic heart disease, hypertension, and larger left ventricular size predict progression to severe mitral regurgitation, whereas beta-blocker use is associated with reduced progression.
Effect estimate: adjusted OR 1.52 for atrial fibrillation, 1.44 for ischaemic heart disease, 1.35 for hypertension, 1.36 per 1 cm increase in LVIDD, 0.74 for beta-blocker use (95% CI aOR atrial fibrillation 1.19 to 1.94; aOR ischaemic heart disease 1.13 to 1.83; aOR hypertension 1.01 to 1.80; aOR LVIDD 1.16 to 1.59; aOR beta-blocker use 0.56 to 1.00)
p-value: p=aFIB p=0.001; IHD p=0.004; HTN p=0.043; LVIDD p<0.001; beta-blocker p=0.046
Background Patients with heart failure (HF) and severe mitral regurgitation (MR) have poor outcomes. Early identification could allow physicians to consider interventions that may improve outcomes. We identified factors associated with progression to severe MR in patients with HF. Methods A total of 11 521 patients with HF and MR were screened, out of which we identified 7391 patients with a clinical diagnosis of HF and at least two echocardiograms at least 6 months apart. We excluded patients without a documented severity of MR at initial (n=1840) or follow-up (n=960) echocardiogram and those with severe MR at initial echocardiogram (n=450). We evaluated factors associated with the development of either moderate to severe or severe MR using multivariable logistic regression analysis. Results A total of 7391 patients were included in the study, 4173 (56.5%) male, and median age 75 (IQR (IQR) 64–83). In total, 357 (4.8%) patients developed severe MR on the follow-up echocardiogram at a median of 1.4 years (IQR 0.9–2.4). In addition to baseline MR severity, atrial fibrillation (adjusted OR (aOR)1.52), ischaemic heart disease (aOR 1.44), hypertension (aOR 1.35) and higher left ventricular end-diastolic dimension (aOR 1.36 per 1 cm) were associated with increased progression to severe MR. Beta-blocker prescription was associated with reduced progression to severe MR (aOR 0.74). Conclusions We identified several factors associated with the progression to severe MR in patients with HF. This information could be used by clinicians to identify patients who require closer echocardiographic follow-up and access to appropriate early interventions.
Ahmed et al. (Thu,) conducted a observational in Adults with heart failure and mitral regurgitation with at least two echocardiograms at least 6 months apart, without severe or moderate-to-severe MR at baseline (n=7,391). In patients with heart failure and mitral regurgitation, 4.8% developed severe MR over 1.4 years; atrial fibrillation (aOR 1.52), ischaemic heart disease (aOR 1.44), hypertension (aOR 1.35), and higher LVIDD (aOR 1.36 per cm) increased risk, while beta-blockers reduced risk (aOR 0.74).