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    Clinical impact of changes in mitral regurgitation severity after medical therapy optimization in heart failure

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    Author
    Samani, Nilesh
    Keyword
    GRMT
    heart failure
    hospitalization
    mitral regurgitation
    mortality
    valvular heart disease
    Date
    2022-08
    
    Metadata
    Show full item record
    Publisher's URL
    https://link.springer.com/article/10.1007/s00392-022-01991-7
    Abstract
    Background: Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-recommended medical therapy (GRMT) in heart failure (HF). Our aim was to evaluate the evolution and impact of MR after GRMT in the Biology study to Tailored treatment in chronic heart failure (BIOSTAT-CHF). Methods: A retrospective post-hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization. Results: Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate-severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate-severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint (unadjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.57-2.63; p < 0.001), also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR, 1.85; 95% CI 1.43-2.39; p < 0.001). Younger age, LVEF ≥ 50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of persistence of moderate-severe MR at 9 months, whereas older age was the only predictor of worsening MR. Conclusions: Among patients with HF undergoing GRMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate-severe MR after GRMT was associated with worse outcome.
    Citation
    Pagnesi, M., Adamo, M., Sama, I. E., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G. S., Inciardi, R. M., Lang, C. C., Lombardi, C. M., Ng, L. L., Ponikowski, P., Samani, N. J., Zannad, F., van Veldhuisen, D. J., Voors, A. A., & Metra, M. (2022). Clinical impact of changes in mitral regurgitation severity after medical therapy optimization in heart failure. Clinical research in cardiology : official journal of the German Cardiac Society, 111(8), 912–923. https://doi.org/10.1007/s00392-022-01991-7
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15708
    Collections
    Cardiology

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