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Clinical impact of changes in mitral regurgitation severity after optimization of medical therapy in heart failure: insights from BIOSTAT-CHF

conference contribution
posted on 2022-03-25, 12:18 authored by Matteo Pagnesi, Marianna Adamo, Iziah E Sama, Stefan D Anker, John G Cleland, Kenneth Dickstein, Gerasimos S Filippatos, Riccardo M Inciardi, Chim C Lang, Carlo M Lombardi, Leong L Ng, Piotr Ponikowski, Nilesh J Samani, Faiez Zannad, Dirk J Van Veldhuisen, Adriaan A Voors, Marco Metra
Aims
Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-directed medical therapy (GDMT) in heart failure (HF). We evaluated the evolution and impact of MR after GDMT in the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF).

Methods and results
A retrospective post hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization. Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate–severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate–severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint [unadjusted hazard ratio (HR), 2.03; 95% confidence interval (CI): 1.57–2.63; P < 0.001], also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR: 1.85; 95% CI: 1.43–2.39; P < 0.001). Younger age, LVEF ≥50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of moderate–severe MR at 9 months, whereas older age was the only predictor of worsening MR.

Conclusions
Among patients with HF undergoing GDMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate–severe MR after GRMT was associated with worse outcome.

History

Citation

European Heart Journal Supplements, Volume 23, Issue Supplement_G, December 2021, suab139.034, https://doi.org/10.1093/eurheartj/suab139.034

Author affiliation

Department of Health Sciences, University of Leicester

Source

82nd SIC National Congress 2021

Version

  • AM (Accepted Manuscript)

Published in

European Heart Journal Supplements

Volume

23

Issue

G

Pagination

(1)

Publisher

OXFORD UNIV PRESS

issn

1520-765X

eissn

1554-2815

Copyright date

2021

Available date

2022-12-08

Language

en

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