Pagnesi Matteo, Adamo Marianna, Ter Maaten Jozine M, Beldhuis Iris E, Cotter Gad, Davison Beth A, Felker G Michael, Filippatos Gerasimos, Greenberg Barry H, Pang Peter S, Ponikowski Piotr, Sama Iziah E, Severin Thomas, Gimpelewicz Claudio, Voors Adriaan A, Teerlink John R, Metra Marco
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2023 Apr;25(4):541-552. doi: 10.1002/ejhf.2820. Epub 2023 Mar 13.
The impact of mitral regurgitation (MR) in patients hospitalized for acute heart failure (AHF) is not well established. We assessed the role of MR in patients enrolled in the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial.
Patients enrolled in RELAX-AHF-2 with available data regarding MR status were included in this analysis. Baseline characteristics, in-hospital data, and clinical outcomes through 180-day follow-up were evaluated. The impact of moderate/severe MR was assessed. Among 6420 AHF patients with known MR status, 1810 patients (28.2%) had moderate/severe MR. Compared to patients with no/mild MR, those with moderate/severe MR were more likely to have history of heart failure (HF), prior HF hospitalization, more comorbidities, symptoms/signs of HF, lower left ventricular ejection fraction and higher N-terminal pro-B-type natriuretic peptide levels. Moderate/severe MR was associated with longer length of hospital stay, higher rates of residual dyspnoea, increased jugular venous pressure through the index hospitalization and a higher unadjusted risk of the composite of cardiovascular (CV) death or rehospitalization for HF/renal failure (RF) through 180 days (crude hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.03-1.27, p = 0.01). The association between moderate/severe MR and poorer outcomes was not maintained in a multivariable model including several covariates of interest (adjusted HR 1.03, 95% CI 0.91-1.17, p = 0.65). Similar findings were observed for HF/RF rehospitalization alone.
In patients with AHF, moderate/severe MR was associated with a worse clinical profile but did not have an independent prognostic impact on clinical outcomes.
二尖瓣反流（MR）对因急性心力衰竭（AHF）住院患者的影响尚未完全明确。我们评估了MR在急性心力衰竭2期松弛素试验（RELAX-AHF-2）入选患者中的作用。
本分析纳入了RELAX-AHF-2试验中有MR状态可用数据的患者。评估了基线特征、住院期间数据以及180天随访期的临床结局。评估了中重度MR的影响。在6420例已知MR状态的AHF患者中，1810例（28.2%）有中重度MR。与无/轻度MR的患者相比，中重度MR患者更可能有心力衰竭（HF）病史、既往HF住院史、更多合并症、HF症状/体征、更低的左心室射血分数以及更高的N末端B型利钠肽前体水平。中重度MR与住院时间延长、残余呼吸困难发生率更高、整个指数住院期间颈静脉压升高以及180天内心血管（CV）死亡或因HF/肾衰竭（RF）再次住院的未调整风险更高相关（粗风险比[HR]1.15，95%置信区间[CI]1.03 - 1.27，p = 0.01）。在包含多个感兴趣协变量的多变量模型中，中重度MR与较差结局之间的关联未得到维持（调整后HR 1.03，95%CI 0.91 - 1.17，p = 0.65）。仅HF/RF再次住院也观察到类似结果。
在AHF患者中，中重度MR与更差的临床特征相关，但对临床结局没有独立的预后影响。
