In HFrEF patients with V-SMR, 3D mitral RegVol/LAVmax independently predicted mortality or HF rehospitalization (HR 1.11 per 5% increase; p<0.001).
Does the 3D mitral RegVol/LAVmax ratio predict all-cause mortality or HF rehospitalization in patients with HFrEF and V-SMR?
The 3D mitral RegVol/LAVmax ratio provides incremental prognostic value beyond conventional echocardiographic parameters for predicting adverse outcomes in patients with HFrEF and V-SMR.
Absolute Event Rate: 0% vs 0%
Abstract Background Determining the severity of ventricular secondary mitral regurgitation (V-SMR) in patients with heart failure and reduced ejection fraction (HFrEF) is challenging. Traditional methods, such as the proximal isovelocity surface area (PISA) technique, may misestimate regurgitant volume (RegVol) due to altered left-sided chamber geometry. A disproportionately dilated left ventricle (LV) further worsens the prognosis associated with V-SMR, while left atrial (LA) size and function also contribute to adverse outcomes. Furthermore, normalizing the mitral RegVol to LV end-diastolic volume (LVEDV) provides a more accurate assessment of MR severity and its prognostic implications. However, the prognostic value of the ratio between mitral RegVol and LA maximum volume (LAVmax) has not been investigated. Objectives This study aimed to assess the prognostic implications of 3D mitral RegVol/LAVmax in patients with HFrEF and at least mild V-SMR. Methods We retrospectively analyzed 153 prospectively acquired transthoracic echocardiography studies performed between January 2020 and June 2023 in patients diagnosed with HFrEF (LV ejection fraction 40%). After applying exclusion criteria (primary mitral disease, significant aortic valve disease, prior valvular intervention, inadequate imaging, missing follow-up), 119 patients (mean age 68 ± 14 years, 79% men) formed the final cohort. Comprehensive two-dimensional, speckle-tracking and 3D echocardiography was performed to quantify V-SMR severity using both the PISA and 3D volumetric methods. The composite endpoint was all-cause mortality or rehospitalization for HF decompensation during a mean follow-up of 20 ± 12 months. Results Fifty-eight patients (48.7%) reached the composite endpoint. Univariable Cox regression identified multiple clinical and echocardiographic parameters (including NYHA class 2, 3D LV volumes, LV global longitudinal strain, pulmonary artery systolic pressure (PASP), both PISA- and 3D-derived RegVol as well as the ratios between 3D RegVol/LAVmax and 3D RegVol/LVEDV as continuous variables and per each 5% increase) as predictors of adverse outcomes. However, in multivariable analysis, 3D RegVol/LAVmax emerged as the sole independent predictor (hazard ratio 1.11 per each 5% increase; p0.001). Patients with 3D RegVol/LAVmax ≥30% had more moderate and severe MR, more dilated and dysfunctional LV and dilated LA, as well as higher PASP, and worse event-free survival at Kaplan-Meier analysis (p=0.001). Finally, adding 3D RegVol/LAVmax to a baseline model including the variables with significance at univariate analysis provided incremental prognostic value (p=0.041) for predicting the outcome. Conclusions In patients with HFrEF and V-SMR, 3D mitral RegVol/LAVmax provides incremental prognostic value beyond conventional echocardiographic parameters. Incorporating this ratio into routine echocardiographic evaluation may enhance risk stratification and guide clinical decision-making.Kaplain-Meier analysis
Hadareanu et al. (Sat,) reported a other. In HFrEF patients with V-SMR, 3D mitral RegVol/LAVmax independently predicted mortality or HF rehospitalization (HR 1.11 per 5% increase; p<0.001).