Ischemic or Nonischemic Functional Mitral Regurgitation and Outcomes in Patients With Acute Decompensated Heart Failure With Preserved or Reduced Ejection Fraction

Kajimoto, Katsuya; Minami, Yuichiro; Otsubo, Shigeru; Sato, Naoki; Asai, Kuniya; Munakata, Ryo; Aokage, Toshiyuki; Yoshida, Asuka; Yumino, Dai; Mizuno, Masayuki; Kawada, Erisa; Yoshida, Kentaro; Ozaki, Yuri; Kogure, Tomohito; Haruki, Shintaro; Nakao, Kōichi; Sawamura, Tadashi; Nuki, Toshiaki; Ishiki, Ryoji; Yokota, Shigeki; Fujinaga, Hiroyuki; Yamamoto, Takashi; Harada, Kenji; Saito, Akihiro; Kageyama, Norihito; Okumura, Takanobu; Hata, Noritake; Murai, Koji; Nozaki, Ayaka; Kawanaka, Hidekazu; Tanabe, Jun; Sato, Yukihito; Ishii, Katsuhisa; Oiwa, Hitoshi; Matsumoto, Tomoaki; Yoshida, Daisuke; Kato, Nobuo; Suzuki, Hiroshi; Shimizu, Nobuyuki; Keida, Takehiko; Fujita, Masaki; Nakamura, Kentaro; Chinen, Toshiya; Meguro, Kentaro; Kikuchi, Tetsuro; Nishikido, Toshiyuki; Nakata, Masao; Yamashita, Tatsuya; Nakata, Masaya; Hirono, Akitoshi; Mitsudo, Kazuaki; Kadota, Kazushige; Makita, Noriko; Watanabe, Nagisa; Kawabata, Masaaki; Fujii, Kenichi; Okuda, Shinichi; Kobayashi, Shigeki; Moriuchi, Ikuo; Mizuno, Kiyo o.; Kazuo, Osato; Murakami, Tatsuaki; Shimada, Yoshifumi; Misawa, Katsushi; Kokado, Hiromasa; Fujita, Takashi; Fukuoka, Yoshitomo; Takabatake, Syu; Takata, Yasuyuki; Miyagi, Manabu; Tanaka, Nobuhiro; Yamashina, Akira; Sudo, Shinji; Shimamura, Koichi; Nagashima, Michitaka; Kaneda, Tomoya; Ueda, Kosei; Kato, Hiromasa; Higashikata, Toshinori; Fujimori, Kanichi; Kobayashi, Hiroshi; Fujii, Shinya; Yagi, Minoru; Takaki, Jyunko; Yamashita, Eiji; Toyama, Takuji; Hirata, Tetsuya; Kamisihima, Kazuho; Oka, Takahiro; Komatsu, Ryushi; Itoh, Akira; Naruko, Takahiko; Abe, Yukio; Nakagawa, Eiichirou; Furukawa, Atsuko; Kinou, Naoto; Uematsu, Shoko; Tabuchi, Isao; Imai, Taku; Sakamoto, Takafumi; Todaka, Koji; Koide, Yuji; Maemura, Koji; Yoshioka, Koichiro; Yoshihisa, Akiomi; Sato, Toshio; Takeishi, Yasuchika; Ebina, Toshiaki; Kimura, Kazuo; Konishi, Masaaki; Kato, Masahiko; Kinugasa, Yoshiharu; Ishida, Katsunori; Sugihara, Shinobu; Yanagihara, Kiyotaka; Takeuchi, Toshiharu; Okada, Motoi; Hasebe, Naoyuki; Sakai, Tetsuo; Asano, Taku; Minoura, Yoshino; Toshida, Tsutomu; Sato, Takatoshi; Yokota, Yuya; Kondo, Seita; Sakata, Yasushi; Komuro, Issei; Otsu, Kinya; Yamashita, Shizuya; Asano, Yoshihiro; Kashiwase, Kazunori; Ueda, Yasunori; Kondo, Taizo; Kawaguchi, Katsuhiro; Sawamura, Akinori; Saito, Taro; Higa, Toru; Noguchi, Hiroo; Yanagita, Yoko; Nakamura, Keita; Komaki, Tomo; Muramatsu, Toshihiro; Koizumi, Tomomi; Nakajima, Yoshie; Kikutani, Toshihiko; Ikeda, Yoshifimi; Tamaki, Toru; Funada, Shuhei; Ogawa, Harumi; Sakuragawa, Koichiro; Kohsaka, Shun; Ando, Shin Ichi; Kadokami, Toshiaki; Ishida, Eiko; ide, katsumi; Sotomi, Yohei; Higuchi, Yoshiharu; Uehara, Motoko; Goto, Toshihiko; Ohte, Nobuyuki; Miura, Masanobu; Shiba, Nobuyuki; Nochioka, Kotaro; Shimokawa, Hiroaki; Ishihara, Shiro; Koga, Tokushi; Fujishima, Shinichiro; Kaseda, Shigeru; Haga, Yoshie; Kida, Kenji; Nakamura, Makiko; Sunagawa, Osahiko; Miyara, Takafumi; Taba, Youji; Toriumi, Takashi; Shinjo, Osamu; Nishimura, Yoshioki; Kario, Kazuomi; Shimizu, Hayato; Uchida, Takahiro; Amitani, Ken ichi; Shimada, Katsunori

doi:10.1016/j.amjcard.2017.05.051

Cited by 21 publications

(17 citation statements)

References 25 publications

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“…Variables that have shown to influence outcomes after discharge were examined in a univariate analysis: age, sex, etiology of cardiomyopathy, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) level on admission, diabetes, atrial fibrillation, predischarge creatinine, presence of chronic resynchronization therapy device, guideline‐directed medical therapy (GDMT) at discharge (beta blockers, angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, diuretics, and angiotensin receptor neprilysin inhibitors) and echocardiographic parameters (left ventricular ejection fraction, left ventricle internal diameter at end diastole and at end systole, left atrial diameter, mitral valve E max velocity). 12 , 14 The purposeful selection of variables methods was then used. 19 Variables with a univariate P <0.2 were entered into an initial model after which a reduced model was derived with all covariates with a P <0.05.…”

Section: Methodsmentioning

confidence: 99%

“…Although we have advanced our understanding of FMR in chronic heart failure, there still remains a paucity of data pertaining to FMR in the setting of acute decompensated heart failure (ADHF). 11 , 12 , 13 , 14 Patients presenting with ADHF are in a state of increased ventricular loading conditions 15 and it remains unclear whether FMR in this setting is simply a marker of preload and after‐load mismatch or if it also carries any long‐term prognostic significance. Notably, FMR in the setting of ADHF is highly susceptible to pharmacological optimization.…”

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confidence: 99%

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Severity of Functional Mitral Regurgitation on Admission for Acute Decompensated Heart Failure Predicts Long‐Term Risk of Rehospitalization and Death

Kataria

Castagna

Madan

et al. 2022

JAHA

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Background Functional mitral regurgitation (FMR) has emerged as a therapeutic target in patients with chronic heart failure and left ventricular systolic dysfunction. The significance of FMR in acute decompensated heart failure remains obscure. We systematically investigated the prevalence and clinical significance of FMR on admission in patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction. Methods and Results The study was a single‐center, retrospective review of patients admitted with acute decompensated heart failure and left ventricular systolic dysfunction between 2012 and 2017. Patients were divided into 3 groups of FMR: none/mild, moderate, and moderate‐to‐severe/severe FMR. The primary outcome was 1‐year post‐discharge all‐cause mortality. We also compared these groups for 6‐month heart failure hospitalization rates. Of 2303 patients, 39% (896) were women. Median left ventricular ejection fraction was 25%. Four hundred and fifty‐three (20%) patients had moderate‐to‐severe/severe FMR, which was independently associated with 1‐year all‐cause mortality. Moderate or worse FMR was found in 1210 (53%) patients and was independently associated with 6‐month heart failure hospitalization. Female sex was independently associated with higher severity of FMR. Conclusions More than half of patients hospitalized with acute decompensated heart failure and left ventricular systolic dysfunction had at least moderate FMR, which was associated with increased readmission rates and mortality. Intensified post‐discharge follow‐up should be undertaken to eliminate FMR amenable to pharmacological therapy and enable timely and appropriate intervention for persistent FMR. Further studies are needed to examine sex‐related disparities in FMR.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Severity of Functional Mitral Regurgitation on Admission for Acute Decompensated Heart Failure Predicts Long‐Term Risk of Rehospitalization and Death

Kataria

Castagna

Madan

et al. 2022

JAHA

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“…The presence of signi cant ischemic mitral regurgitation in patients with a history of myocardial infarction and heart failure with reduced ejection fraction signi cantly worsens the long-term prognosis, regardless of the LVEF, age, and NYHA functional class [11][12]. In contrast to primary mitral regurgitation, there is still no clear evidence whether a reduction in secondary mitral regurgitation is associated with improved survival [13].…”

Section: Discussionmentioning

confidence: 99%

Mitral Regurgitation Severity Dynamic During Acute Decompensated Heart Failure Treatment.

Bugała

Rubiś

Hołda

et al. 2021

Preprint

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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 volume 44.92±22.83 vs. 30.88±18.77 ml, p<0.001; EROA 0.37±0.17 vs. 0.25±0.16 cm2, p<0.001; VC 6.21±1.48 vs. 5.26±1.61 mm, p<0.001). Left atrial area (35.86±9.11 vs. 32.47±9.37, p<0.001) and mitral annular diameter (42.33±6.63 vs. 39.72±5.05. p<0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73±13.88 vs. 40.24±13.19 %, p<0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class.Conclusions: Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.

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“…The presence of significant ischemic mitral regurgitation in patients with a history of myocardial infarction and heart failure with reduced ejection fraction significantly worsens the long-term prognosis, regardless of the LVEF, age, and NYHA functional class [11,12]. In contrast to primary mitral regurgitation, there is still no clear evidence whether a reduction in secondary mitral regurgitation is associated with improved survival [13].…”

Section: Discussionmentioning

confidence: 99%

Mitral regurgitation severity dynamic during acute decompensated heart failure treatment

Bugała

Rubiś

Hołda

et al. 2021

Int J Cardiovasc Imaging

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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. 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. 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 volume 44.92 ± 22.83 vs. 30.88 ± 18.77 ml, p < 0.001; EROA 0.37 ± 0.17 vs. 0.25 ± 0.16 cm2, p < 0.001; VC 6.21 ± 1.48 vs. 5.26 ± 1.61 mm, p < 0.001). Left atrial area (35.86 ± 9.11 vs. 32.47 ± 9.37, p < 0.001) and mitral annular diameter (42.33 ± 6.63 vs. 39.72 ± 5.05. p < 0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73 ± 13.88 vs. 40.24 ± 13.19%, p < 0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class. Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.

show abstract

Ischemic or Nonischemic Functional Mitral Regurgitation and Outcomes in Patients With Acute Decompensated Heart Failure With Preserved or Reduced Ejection Fraction

Cited by 21 publications

References 25 publications

Severity of Functional Mitral Regurgitation on Admission for Acute Decompensated Heart Failure Predicts Long‐Term Risk of Rehospitalization and Death

Severity of Functional Mitral Regurgitation on Admission for Acute Decompensated Heart Failure Predicts Long‐Term Risk of Rehospitalization and Death

Mitral Regurgitation Severity Dynamic During Acute Decompensated Heart Failure Treatment.

Mitral regurgitation severity dynamic during acute decompensated heart failure treatment

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