Severe functional mitral regurgitation was a significant independent predictor of mortality in HFrEF patients (HR 1.76; 95% CI 1.34-2.30; P<0.001), particularly in an intermediate-failure phenotype.
Observational (n=576)
Effect estimate: HR 1.76 (95% CI 1.34-2.30)
p-value: p=<0.001
Aims: Significant efforts are currently undertaken to reduce functional mitral regurgitation (FMR) in patients with chronic heart failure in the hope to improve prognosis. We aimed to assess the prognostic impact of FMR in heart failure with reduced ejection fraction (HFrEF) under optimal medical therapy (OMT) and various conditions of HFrEF. We further intended to identify a heart failure phenotype, where FMR is most likely a driving force and not a mere bystander of the disease. Methods and results: We prospectively included 576 consecutive HFrEF patients into our long-term observational study. Functional i.e. New York Heart Association (NYHA) class, echocardiographic, invasive haemodynamic, and biochemical (i.e. NT-proBNP, MR-proANP, MR-proADM, CT-proET-1, copeptin) measurements were performed at baseline. During a median follow-up of 62 months (interquartile range 52-76), 47% of patients died. Severe FMR was a significant predictor of mortality hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.34-2.30; P < 0.001, independent of clinical (adjusted HR 1.61, 95% CI 1.22-2.12; P = 0.001), and echocardiographic (adjusted HR 1.46, 95% CI 1.09-1.94; P = 0.01) confounders, OMT (adjusted HR 1.81, 95% CI 1.25-2.63; P = 0.002), and neurohumoral activation (adjusted HR 1.38, 95% CI 1.03-1.84; P = 0.03). Subanalysis revealed that severe FMR was associated with poor outcome in an intermediate-failure phenotype of HFrEF i.e. patients with NYHA class II (adjusted HR 2.17, 95% CI 1.07-4.44; P = 0.03) and III (adjusted HR 1.80, 95% CI 1.17-2.77; P = 0.008), moderately reduced left ventricular function (adjusted HR 2.37, 95% CI 1.36-4.12; P = 0.002), and within the second quartile (871-2360 pg/mL) of NT-proBNP (adjusted HR 2.16, 95% CI 1.22-3.86; P = 0.009). Conclusion: In a patient cohort under OMT, the adverse prognostic impact of FMR is given predominantly in a sub-cohort of a specific intermediate-failure phenotype-well-defined functionally, haemodynamically, biochemically, and morphologically.
“Perhaps the most important finding in this context is that mitral regurgitation primarily influences the survival of those patients whose heart failure is not yet very advanced. This indicates that there is a particular 'window of opportunity' that should be used to make an appropriate intervention.”
Goliasch et al. (2017) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=576). Severe functional mitral regurgitation (FMR) was evaluated on Mortality (HR 1.76, 95% CI 1.34-2.30, p=<0.001). Severe functional mitral regurgitation was a significant independent predictor of mortality in HFrEF patients (HR 1.76; 95% CI 1.34-2.30; P<0.001), particularly in an intermediate-failure phenotype.