Functional mitral regurgitation (FMR) is a common finding in patients with acute heart
failure (AHF) and reduced left ventricular ejection fraction (heart failure and reduced
ejection fraction [HFrEF]). However, its clinical impact remains unclear. We aimed
to evaluate the association between the severity of FMR after clinical stabilization
and short-term adverse outcomes after a hospitalization for AHF. We prospectively
included 938 consecutive patients with HFrEF discharged after a hospitalization for
AHF, after excluding those with organic valve disease, congenital heart disease, or
aortic valve disease. FMR was assessed semiquantitatively by color Doppler analysis
of the regurgitant jet area, and its severity was categorized as none or mild (grade
0 or 1), moderate (grade 2), or severe (grade 3 or 4). FMR was assessed at 120 ± 24
hours after admission. The primary end point was the composite of all-cause mortality
and rehospitalization at 90 days. At discharge, 533 (56.8%), 253 (26.9%), and 152
(16.2%) patients showed none-mild, moderate, and severe FMR. At the 90-day follow-up,
161 patients (17.2%) either died (n = 49) or were readmitted (n = 112). Compared with
patients with none or mild FMR, rates of the composite end point were higher for patients
with moderate and severe FMRs (p <0.001). After the multivariable adjustment, those
with moderate and severe FMRs had a significantly higher risk of reaching the end
point (hazard ratio = 1.50, 95% confidence interval 1.04 to 2.17, p = 0.027; and hazard
ratio = 1.63, 95% confidence interval 1.07 to 2.48, p = 0.023, respectively). In conclusion,
FMR is a common finding in patients with HFrEF, and its presence, when moderate or
severe, identifies a subgroup at higher risk of adverse clinical outcomes at short
term.
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Article Info
Publication History
Published online: July 25, 2017
Accepted:
July 3,
2017
Received:
March 23,
2017
Footnotes
This work was supported in part by grants 16/11/00420 and 16/11/00403 from Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares , and by grant PIE15/00013 from Fondo Europeo de Desarrollo Regional , Spain.
See page 1347 for disclosure information.
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