Mazin Israel, Arad Michael, Freimark Dov, Goldenberg Ilan, Kuperstein Rafael
Heart Institute, Cardiology Division, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan 5365601, Israel.
Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY 14642, USA.
J Clin Med. 2022 Jul 22;11(15):4267. doi: 10.3390/jcm11154267.
Aims: Data about the prognostic interplay between mitral regurgitation MR and left ventricular (LV) function in the outcome of patients admitted with acute heart failure (AHF) are scarce. We evaluated the prognostic impact of MR severity and LV function on mortality and on recurrent heart failure hospitalization (re-HFH) in patients admitted with AHF. Methods and Results: In total, 6843 patients admitted with AHF were evaluated: 2521 patients with LV ejection fraction (LVEF) ≤ 40% (reduced LVEF), 1238 of them (51%) having ≥moderate MR; and 4322 with LVEF > 40% (preserved LVEF), 1175 of them (27%) having ≥moderate MR. One-year mortality and re-HFH rates were higher in patients with ≥moderate MR unrelated to the baseline LV function (p = 0.028 and p < 0.001, respectively). After multivariable analysis, only reduced LVEF, and not the severity of MR, predicted mortality risk (HR: 1.31 [95% CI: 1.12−1.53] for patients with reduced LV function and ≤mild MR; HR: 1.44 [95% CI: 1.25−1.67] for patients with reduced LV function and ≥moderate MR); p < 0.001 for both. There was an increased risk for re-HFH in each group (HR: 1.35 [95% CI: 1.17−1.52] for patients with preserved LV function and ≥moderate MR; HR: 1.31 [95% CI: 1.15−1.51] for patients with reduced LV function and mild MR; and HR: 1.65 [95% CI: 1.45−1.88] for patients with reduced LV function and ≥moderate MR); p < 0.001 for all. Conclusions: In patients admitted with AHF, the LV function is the main prognostic determinant for mortality after 1 year. Significant (≥moderate) MR is associated with an increased risk of recurrent hospitalization.
关于急性心力衰竭（AHF）患者结局中二尖瓣反流（MR）与左心室（LV）功能之间预后相互作用的数据稀缺。我们评估了MR严重程度和LV功能对AHF患者死亡率及再发性心力衰竭住院（re-HFH）的预后影响。
总共评估了6843例AHF住院患者：2521例左心室射血分数（LVEF）≤40%（LVEF降低）的患者，其中1238例（51%）有≥中度MR；4322例LVEF>40%（LVEF保留）的患者，其中1175例（27%）有≥中度MR。≥中度MR患者的一年死亡率和再发性HFH率更高，与基线LV功能无关（分别为p = 0.028和p < 0.001）。多变量分析后，只有LVEF降低而非MR严重程度可预测死亡风险（LV功能降低且≤轻度MR的患者HR：1.31 [95% CI：1.12 - 1.53]；LV功能降低且≥中度MR的患者HR：1.44 [95% CI：1.25 - 1.67]）；两者p均< 0.001。每组再发性HFH风险均增加（LV功能保留且≥中度MR的患者HR：1.35 [95% CI：1.17 - 1.52]；LV功能降低且轻度MR的患者HR：1.31 [95% CI：1.15 - 1.51]；LV功能降低且≥中度MR的患者HR：1.65 [95% CI：1.45 - 1.88]）；所有p均< 0.001。
在AHF住院患者中，LV功能是1年后死亡率的主要预后决定因素。显著（≥中度）MR与再住院风险增加相关。
