Heart failure & cardiomyopathiesCohort study
Secondary Mitral Regurgitation Trajectories and Prognosis With Intensification of Guideline-Directed Medical Therapy in Heart Failure
- Prospective cohort study
Authors' conclusion
In this real-world HFrEF cohort, optimizing GDMT use led to SMR improvement in over half of patients with moderate or severe SMR. Nevertheless, both persistent moderate and severe SMR were associated with poor outcomes
Study context
- Population
- Ambulatory heart failure with reduced ejection fraction (HFrEF) patients with baseline and 12-month TTE under optimized guideline-directed medical therapy (GDMT), excluding mitral valve interventions
- Participants
- 2,254 patients
- Exposure
- Secondary mitral regurgitation (SMR) trajectory over 12 months of optimized GDMT: persistent significant vs improved vs consistently nonsignificant SMR
- Outcome
- All-cause mortality
- Follow-up
- Median 4.5 years after the 12-month TTE
Main finding
As reported in the abstract
Hazard ratio
1.60
95% CI 1.36–1.89
P < 0.001
Observational data: associations, not effects.
Secondary outcomes
All-cause mortality or heart failure hospitalization (HFH)
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Persistent significant SMR | 1.59 (1.36–1.85) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
SMR distribution, baseline vs 12 months (nonsignificant/moderate/severe)
- Baseline: none or mild / moderate / severe
- 67.6% / 25.2% / 7.3%
- 12 months: nonsignificant / moderate / severe
- 79.5% / 16.5% / 4.2%
- Shift in distribution
- P < 0.001
Improvement to nonsignificant SMR among 731 with significant SMR at baseline · 12 months
- Improved to nonsignificant SMR
- 57.5%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it