Evolution of secondary mitral regurgitation

Area of Science:

• Cardiology
• Heart Failure Research
• Valvular Heart Disease

Background:

• Secondary mitral regurgitation (MR) is a key driver of adverse cardiac remodeling in heart failure.
• The natural history of MR under guideline-directed therapy (GDT) and its impact on outcomes remain incompletely understood.
• Understanding MR progression is vital for refining heart failure management strategies.

Purpose of the Study:

• To evaluate the incidence and predictors of progressive secondary MR in patients receiving GDT.
• To assess the impact of MR progression on long-term mortality in this cohort.
• To identify clinical and echocardiographic markers associated with MR progression.

Main Methods:

• Prospective enrollment of 249 patients with chronic heart failure and reduced ejection fraction on GDT.
• Long-term observational study with a median follow-up of 61 months.
• Assessment of MR severity, neurohumoral activation, left atrial size, and tricuspid regurgitation (TR).

Main Results:

• 19% of patients with initially non-severe MR experienced progression.
• Progressive MR was associated with increased symptomatic status, neurohumoral activation, larger left atrial size, and TR.
• MR progression independently predicted increased mortality (adjusted HR 2.48).

Conclusions:

• MR progression affects approximately one in five patients with chronic heart failure on GDT.
• Progressive secondary MR significantly elevates the risk of death, even after adjusting for confounders.
• Symptomatic status, left atrial size, TR, and neurohumoral markers can identify patients at risk for MR progression, guiding closer monitoring and intervention.