Article Text
Abstract
Objective The impact of the severity of secondary mitral regurgitation (MR) on the risk of death and heart failure (HF) hospitalisations in patients with reduced left ventricular (LV) systolic function is poorly defined. The study sought to identify the incremental risk of secondary MR in patients with reduced LV systolic function.
Methods We studied 615 consecutive patients with LV ejection fraction ≤35% by transthoracic echocardiography at a single medical centre. Patients were divided into three groups of no MR, mild, or moderate to severe MR. The median follow-up was 2.9 years. The primary endpoint was a composite of death or HF hospitalisations.
Results Compared with patients with no MR, the risk of death or HF hospitalisations was higher for mild MR (HR 1.7, P=0.003) and moderate to severe MR (HR 2.7, P<0.001). The risk was also higher for the component endpoints of HF hospitalisations (mild MR: HR 2.3, P=0.001; moderate to severe MR: HR 3.5, P<0.001) and death (mild MR: HR 1.6, P=0.033; moderate to severe MR: HR 2.6, P<0.001). After adjustment for other covariates, MR was no longer significantly associated with death or HF hospitalisations, or death alone, but remained significantly associated with HF hospitalisations (mild MR: HR 1.7, P=0.028; moderate to severe MR: HR 2.2, P=0.002).
Conclusions In patients with reduced LV systolic function, secondary MR is associated with an increased risk of HF hospitalisations but not death.
- secondary mitral regurgitation
- death
- heart failure hospitalization
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Footnotes
This study was conducted in the Veterans Administration Boston Healthcare System in West Roxbury, Massachusetts, USA. The findings of this study were presented in poster format at the American Society of Echocardiography Scientific Sessions in Minneapolis, Minnesota, USA, 2013.
SM and AD contributed equally.
Contributors SM and AD: study design and interpretation of data; drafting of manuscript. JRG, KGA and SE: interpretation of data and revision of manuscript. GP: study design and revision of manuscript. ZC: study design and interpretation of data; revision of manuscript. SK: analysis and interpretation of data; revision of manuscript. JA: study design and analysis/interpretation of data; revision of manuscript.
Competing interests None declared.
Ethics approval The VA Central Institutional Review Board.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement No additional data are available.