Impact of mitral regurgitation in patients with worsening heart failure: insights from <scp>BIOSTAT‐CHF</scp>

Pagnesi, Matteo; Adamo, Marianna; Sama, Iziah E.; Anker, Stefan D.; Cleland, John G.F.; Dickstein, Kenneth; Filippatos, Gerasimos; Lang, Chim C.; Ng, Leong L.; Ponikowski, Piotr; Ravera, Alice; Samani, Nilesh J.; Zannad, Faı̈ez; Veldhuisen, Dirk J. van; Voors, Adriaan A.; Metra, Marco

doi:10.1002/ejhf.2276

Cited by 35 publications

(48 citation statements)

References 43 publications

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“…Up to one‐third of HFrEF patients present severe mitral secondary regurgitation (SMR), which is associated with poor outcomes 24,170,171 . Percutaneous edge‐to‐edge mitral valve repair has become a safe, widespread option for patients with HF and SMR 1,23,24,172 .…”

Section: Non‐pharmacological Therapiesmentioning

confidence: 99%

“…Up to one-third of HFrEF patients present severe mitral secondary regurgitation (SMR), which is associated with poor outcomes. 24,170,171 Percutaneous edge-to-edge mitral valve repair has become a safe, widespread option for patients with HF and SMR. 1,23,24,172 Patients with no or low-grade residual mitral regurgitation at discharge and after 12 months from correction of mitral regurgitation with the MitraClip system showed better outcomes compared with patients with higher degree of residual mitral regurgitation.…”

Section: Percutaneous Treatment Of Mitral or Tricuspid Regurgitationmentioning

confidence: 99%

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A year in heart failure: an update of recent findings

et al. 2021

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Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.

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Section: Non‐pharmacological Therapiesmentioning

confidence: 99%

Section: Percutaneous Treatment Of Mitral or Tricuspid Regurgitationmentioning

confidence: 99%

A year in heart failure: an update of recent findings

et al. 2021

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“…Functional mitral regurgitation (FMR) has a well‐established prognostic impact in HF patients 25,26 . Malagoli et al 27 .…”

Section: Comorbiditiesmentioning

confidence: 99%

“…Functional mitral regurgitation (FMR) has a well-established prognostic impact in HF patients. 25,26 Malagoli et al 27 analysed the role of FMR, quantified by effective regurgitant orifice area (EROA), on CV outcome and its interplay with left atrial (LA) function. In this prospective cohort, including 286 HFrEF patients, EROA ≥0.30 cm 2 was associated with CV events regardless of LA function while LA function mitigated the effects of less severe FMR (EROA ≥0.10 cm 2 ).…”

Section: Mitral Regurgitationmentioning

confidence: 99%

April 2022 at a glance: focus on prevention, acute heart failure and heart failure with preserved ejection fraction

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Spironolactone has proven effective in reducing heart failure (HF) hospitalizations in patients with HF and preserved ejection fraction (HFpEF). 1 A recent study randomized asymptomatic patients with left ventricular dysfunction, defined as global longitudinal strain ≤16% or diastolic abnormalities, to spironolactone or placebo. The primary endpoint was incident HF. The trial was prematurely terminated, and thus unpowered, because of a 55% withdrawal of spironolactone due to decline in renal function. However, resolution of left ventricular dysfunction occurred more frequently with spironolactone versus placebo (59% vs. 33%, p = 0.01). 2 Type 2 diabetes is a well-known cardiovascular (CV) risk factor. [3][4][5] In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study, patients with cardiac autonomic neuropathy, compared to those without, had a 2.7-fold higher risk to develop HF, over a median follow-up of 4.9 years. 6 Acute heart failureAn analysis from REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) showed the precipitating factors leading to acute HF, focusing on inter-regional differences and outcome. 7 Acute coronary syndrome (ACS) was the most common cause of new-onset HF in all regions except Western Europe and North America. 7,8 On the other hand, non-adherence to diet/medication was the most common precipitant in patients with decompensated HF in all regions, confirming its major role for patient outcomes. 7,[9][10][11] Cardiogenic shock is still burdened by high mortality, requiring an early risk stratification. 12 Beer et al. 13 proposed a novel risk score, the Cardiogenic Shock Score (CSS), which was derived in 1308 unselected patients and validated in an external cohort of 943 patients. The novel score, based on nine clinical variables (age, sex, ACS, systolic blood pressure, heart rate, pH, lactate, glucose and cardiac arrest), had a higher prediction power compared to any other score in both the index and validation cohort.

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“…In this issue of the Journal, Pagnesi and colleagues present a novel perspective on MR 8 . The post‐hoc analysis included 4023 patients from derivation and validation cohorts of the prospective multicentre BIOSTAT‐CHF study, 9 which enrolled individual patients with new‐onset or worsening chronic heart failure between 2010–2014.…”

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Mitral regurgitation tips the scales in acute or worsening heart failure

Bartko

Kreidel

Bardeleben

et al. 2021

European J of Heart Fail

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This article refers to 'Impact of mitral regurgitation in patients with worsening heart failure: insights from BIOSTAT-CHF' by M. Pagnesi et al., published in this issue on pages 1750-1758.Mitral regurgitation (MR) in patients with heart failure impairs quality of life, increases rates of hospital admission, and has a poor prognosis. [1][2][3][4] The prevalence of MR is substantial and expected to gain ground with population ageing indicating increasing demands on public health care systems in the future. 1,2 Much of these aspects have been studied in patient cohorts recruited and followed in specialized heart failure clinics after optimized guideline-directed heart failure treatment. [2][3][4][5][6][7] Often, the disease has augmented myocardial impairment and damage with limited capacity for recovery and paved the way towards a trajectory of irreversible failure. 4 In this issue of the Journal, Pagnesi and colleagues present a novel perspective on MR. 8 The post-hoc analysis included 4023 patients from derivation and validation cohorts of the prospective multicentre BIOSTAT-CHF study, 9 which enrolled individual patients with new-onset or worsening chronic heart failure between 2010-2014. The primary endpoint was a composite of heart failure hospitalizations and all-cause mortality, secondary endpoints were all-cause mortality and cardiovascular mortality. The majority of patients had heart failure with reduced ejection fraction (67%), followed by heart failure with mid-range ejection fraction (18%) and heart failure with preserved ejection fraction (15%). Overall, 41% had more than or equal to moderate MR which was more frequently encountered with lower ejection fraction. Although the aetiology of MR was presumably secondary MR in the majority of patients, patients with primary valve disease were not specifically excluded by study design. Baseline characteristics of more severe MR indicated more symptoms, a lower quality of life and features of adverse cardiac remodelling -potentially a cause or result of volume overload, i.e. larger left ventricular and left atrial dimensions. Furthermore, patients with significant MR moreThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Impact of mitral regurgitation in patients with worsening heart failure: insights from BIOSTAT‐CHF

Abstract: Few data regarding the prevalence and prognostic impact of mitral regurgitation (MR) in patients with worsening chronic or new-onset acute heart failure (HF) are available. We investigated the role of MR in the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF).

Cited by 35 publications

References 43 publications

A year in heart failure: an update of recent findings

A year in heart failure: an update of recent findings

April 2022 at a glance: focus on prevention, acute heart failure and heart failure with preserved ejection fraction

Mitral regurgitation tips the scales in acute or worsening heart failure

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