Disproportionate mitral regurgitation is associated with survival in acute heart failure with moderate range ejection fraction (original) (raw)
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Disproportionate Mitral Regurgitation Determines Survival in Acute Heart Failure
Frontiers in Cardiovascular Medicine, 2021
Objectives: To assess the prevalence and impact of mitral regurgitation (MR) on survival in patients presenting to hospital in acute heart failure (AHF) using traditional echocardiographic assessment alongside more novel indices of proportionality.Background: It remains unclear if the severity of MR plays a significant role in determining outcomes in AHF. There is also uncertainty as to the clinical relevance of indexing MR to left ventricular volumes. This concept of disproportionality has not been assessed in AHF.Methods: A total of 418 consecutive patients presenting in AHF over 12 months were recruited and followed up for 2 years. MR was quantitatively assessed within 24 h of recruitment. Standard proximal isovelocity surface area (PISA) and a novel proportionality index of effective regurgitant orifice/left ventricular end-diastolic volume (ERO/LVEDV) >0.14 mm2/ml were used to identify severe and disproportionate MR.Results: Every patient had MR. About 331/418 (78.9%) patien...
TURKISH JOURNAL OF MEDICAL SCIENCES, 2020
Background/aim: Diagnosing and managing functional mitral regurgitation (MR) is often challenging and requires an integrated approach including a comprehensive echocardiographic examination. However, the effects of volume overload on the echocardiographic assessment of MR severity are uncertain. The purpose of this study was to weigh the effects of volume overload in the echocardiographic assessment of MR severity among patients with heart failure (HF).Materials and methods: Twenty-nine patients with decompensated HF, who had moderate or severe MR, were included in the present study. The volume status and the N-terminal pro-B-type natriuretic peptide (proBNP) levels were recorded and the echocardiographic parameters were assessed. After the conventional treatment for HF, the proBNP levels and the echocardiographic parameters were assessed again.Results: The mean age of the patients was 72 ± 9 years and the average hospitalization time was 10.9 ± 5.9 days. Between the beginning and t...
Mitral Regurgitation Severity Dynamic During Acute Decompensated Heart Failure Treatment
2021
Purpose: Acute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. Methods: The study included 27 consecutive adult patients (40.7% females, mean age 71.19±11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Results: Significant reduction in dyspnea intensity [0-100 scale] (81.48±9.07 vs. 45.00±11.04 pts, p<0.001), body weight (84.98±18.52 vs. 79.77±17.49 kg, p<0,001), and NT-proBNP level (7520.56±5288.62 vs. 4949.88±3687.86 pg/ml, p=0.001) was found. The severity of MR parameters decreased significantly (MR...
The American Journal of Cardiology, 2017
The aim of this study was to evaluate the association of functional mitral regurgitation (FMR), preserved or reduced ejection fraction (EF), and ischemic or non-ischemic etiology with outcomes in patients discharged alive after hospitalization for acute decompensated heart failure (HF). Of the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3357 patients were evaluated to assess the association of FMR, preserved or reduced EF, and ischemic or non-ischemic etiology with the primary endpoint (all-cause death and readmission for HF after discharge). At the time of discharge, FMR was assessed semiquantitatively (classified as none, mild, or moderate/severe) by color Doppler analysis of the regurgitant jet area. According to multivariable analysis, in the ischemic group, either mild or moderate/severe FMR in patients with a preserved EF had a significantly higher risk of the primary endpoint than patients without FMR (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.12-2.29; P=0.010 and HR, 1.98; 95% CI, 1.30-3.01; P=0.001, respectively). In reduced EF patients with an ischemic etiology, only moderate/severe FMR was associated with a significantly higher risk of the primary endpoint (HR, 1.67; 95% CI, 1.11-2.50; P=0.014). In the non-ischemic group, there was no significant association between FMR and the primary endpoint in patients with either a preserved or reduced EF. In conclusion, among acute decompensated HF patients with a preserved or reduced EF, the association of FMR with adverse outcomes may differ between patients who had an ischemic or non-ischemic etiology of HF.
The American Journal of Cardiology, 2003
The goal of this study was to examine the frequency of mitral regurgitation (MR) in patients with left ventricular (LV) systolic dysfunction and to relate its presence and severity to long-term survival. Remodeling of the left ventricle after myocyte injury leads to a progressive change in LV size and shape, and it may lead to the development of MR. The frequency of MR and its relation to survival in patients with LV systolic dysfunction has not been completely characterized. We analyzed the histories, coronary anatomy, and degree of MR in patients with symptomatic heart failure and LV ejection fraction <40% who underwent cardiac catheterization between 1986 and 2000. Cox's proportional hazards modeling was used to assess the independent effect of MR on survival. Two thousand fifty-seven patients met study criteria; MR was common in this cohort (56.2%).
The American Journal of Cardiology, 2017
Functional mitral regurgitation (FMR) is a common finding among patients with acute heart failure (AHF) and reduced left ventricular 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 following a hospitalization for AHF. We prospectively included 938 consecutive patients with HFrEF discharged following a hospitalization for AHF, after excluding those with organic valve disease, congenital heart disease or aortic valve disease. FMR was assessed semi-quantitatively by color Doppler analysis of the regurgitant jet area and its severity categorized as: none or mild (grade 0-I), moderate (grade II), or severe (grade III-IV). 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 90-day follow-up, 161 patients (17.2%) either died (n=49) or were readmitted (n=112). Compared to patients with none or mild FMR, rates of the composite endpoint were higher for patients with moderate and severe FMR (p<0,001). After multivariable adjustment, those with moderate and severe FMR had a significantly higher risk of reaching the endpoint [(HR=1.50; 95% CI: 1.04-2.17; p=0.027), and (HR=1.63; 95% CI: 1.07-2.48; p=0.023), respectively]. In conclusion, FMR is a common finding among patients with HFrEF and its presence, when moderate/severe identifies a subgroup at higher risk of adverse clinical outcomes at short-term.
International Journal of Cardiology, 2018
Background: Severe mitral regurgitation (MR) on hospital arrival at the onset of acute decompensated heart failure (ADHF) can improve after ADHF treatment because MR is dynamic in nature. This study investigated the clinical significance of the dynamic severe MR on hospital arrival in ADHF patients. Methods: Transthoracic echocardiography was performed on 784 patients hospitalized for ADHF both on arrival and after ADHF treatment, of whom 563 with at least mild MR after ADHF treatment were enrolled and divided into 3 groups based on the MR severity: severe at both times (persistent MR, n = 106); severe on arrival and improved to mild/moderate after ADHF treatment (dynamic MR, n = 149); and mild/moderate at both times (non-significant MR, n = 308). The primary outcome measure was defined as a composite of cardiac death, rehospitalization for heart failure, and mitral valve intervention within 1-year. Results: The incidence of the primary outcome measure in the dynamic MR group (44.8%) was significantly higher than that in the non-significant MR group (22.1%, adjusted hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.34-0.73, P b 0.001), and similar to that in the persistent MR group (44.4%, adjusted HR: 1.08, 95% CI: 0.69-1.67, P = 0.75). The risk of dynamic MR was consistent in the subgroups of patients with reduced (b45%) and preserved left ventricular ejection fraction (P interaction = 0.56). Conclusions: In patients hospitalized for ADHF, dynamic severe MR on hospital arrival was associated with poorer outcomes than non-significant MR and had similar risk to persistent severe MR. Acute dynamic MR is a potential therapeutic target in ADHF patients.
European Journal of Heart Failure, 2019
Patients with chronic heart failure and a reduced ejection fraction commonly show evidence of functional mitral regurgitation (MR), which may result from two distinct pathophysiological mechanisms. 1 First, MR can occur primarily as a result of enlargement of the left ventricle, which leads to mitral annular dilatation and the tethering of the valve leaflets by displaced papillary muscles. Second, MR can be caused by left ventricular (LV) dyssynchrony due to a localized electrical or mechanical disturbance that leads to uncoordinated support of the valve leaflets during systole. Although the degree of MR may be mild and of little consequence, one-third of patients with chronic heart failure manifest severe MR, which is related to either LV enlargement or LV dyssynchony. 2 Identifying patients with disproportionate functional mitral regurgitation The two mechanisms leading to functional MR can be distinguished in the clinical setting. 3 When the principal reason for MR is LV enlargement, there is a predictable relationship between LV end-diastolic volume (LVEDV) and the effective regurgitant orifice area (EROA), assessed by Doppler echocardiography. An EROA of 0.1-0.2 cm 2 can be expected when the LVEDV is 150-200 mL, whereas an LVEDV of 250-300 mL generally leads to EROA of 0.3-0.4 cm 2 (i.e. severe MR). A patient who has severe MR in association with an LVEDV of 250-300 mL has a regurgitant lesion that is proportionate to the LVEDV, i.e. the MR can be explained entirely by LV enlargement. In contrast, when the EROA is of 0.3-0.4 cm 2 but the LVEDV is only 150-200 mL, the degree of MR is much greater than expected from the LV chamber size; i.e. the MR is disproportionate to LV dilatation, typically because it is related to LV dyssynchrony. Thus, distinguishing between proportionate and disproportionate MR allows