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All-Cause Mortality in Ischemic Heart Failure Patients with Functional Mitral Regurgitation Undergoing Percutaneous

Anping Cai1, Weida Qiu2, Xiaoju Xiao2

  • 1Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

The American Journal of Cardiology
|March 20, 2022
PubMed

Insights

Percutaneous coronary intervention (PCI) may improve survival in ischemic heart failure patients with moderate-to-severe functional mitral regurgitation (FMR). PCI showed no significant mortality benefit in patients with none-to-mild FMR.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Research

Background:

  • Ischemic heart failure with left ventricular systolic dysfunction and functional mitral regurgitation (FMR) presents a significant clinical challenge.
  • The role of percutaneous coronary intervention (PCI) in improving outcomes for these patients remains incompletely understood.

Purpose of the Study:

  • To evaluate the association between PCI treatment and all-cause mortality in patients with ischemic heart failure and left ventricular systolic dysfunction.
  • To specifically assess this association in patients stratified by the severity of functional mitral regurgitation (FMR).

Main Methods:

  • A cohort of 1,483 patients with ischemic heart failure was analyzed.
  • Multivariable Cox proportional hazard models and propensity score matching were employed to assess the impact of PCI on all-cause mortality.
  • Patients were categorized based on the severity of FMR (none-to-mild vs. moderate-to-severe).

Main Results:

  • In patients with moderate-to-severe FMR, PCI treatment was associated with a significantly lower rate of all-cause mortality (adjusted HR 0.660, p=0.017), confirmed by propensity matching (HR 0.596, p=0.038).
  • No significant difference in all-cause mortality was observed between PCI and non-PCI groups in patients with none-to-mild FMR (adjusted HR 0.731, p=0.232).
  • The observed mortality benefit of PCI in moderate-to-severe FMR was consistent across various demographic and clinical subgroups.

Conclusions:

  • Percutaneous coronary intervention (PCI) treatment is associated with improved all-cause mortality in patients suffering from ischemic heart failure with moderate-to-severe functional mitral regurgitation (FMR).
  • PCI did not demonstrate a significant survival benefit for patients with none-to-mild FMR.
  • Further validation through randomized clinical trials is warranted to confirm these findings.

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