Mitral regurgitation tips the scales in acute or worsening heart failure

Abstract

This article refers to 'Impact of mitral regurgitation in patients with worsening heart failure: insights from BIOSTAT-CHF' by M. Pagnesi et al., published in this issue on pages 1750-1758.Mitral regurgitation (MR) in patients with heart failure impairs quality of life, increases rates of hospital admission, and has a poor prognosis. [1][2][3][4] The prevalence of MR is substantial and expected to gain ground with population ageing indicating increasing demands on public health care systems in the future. 1,2 Much of these aspects have been studied in patient cohorts recruited and followed in specialized heart failure clinics after optimized guideline-directed heart failure treatment. [2][3][4][5][6][7] Often, the disease has augmented myocardial impairment and damage with limited capacity for recovery and paved the way towards a trajectory of irreversible failure. 4 In this issue of the Journal, Pagnesi and colleagues present a novel perspective on MR. 8 The post-hoc analysis included 4023 patients from derivation and validation cohorts of the prospective multicentre BIOSTAT-CHF study, 9 which enrolled individual patients with new-onset or worsening chronic heart failure between 2010-2014. The primary endpoint was a composite of heart failure hospitalizations and all-cause mortality, secondary endpoints were all-cause mortality and cardiovascular mortality. The majority of patients had heart failure with reduced ejection fraction (67%), followed by heart failure with mid-range ejection fraction (18%) and heart failure with preserved ejection fraction (15%). Overall, 41% had more than or equal to moderate MR which was more frequently encountered with lower ejection fraction. Although the aetiology of MR was presumably secondary MR in the majority of patients, patients with primary valve disease were not specifically excluded by study design. Baseline characteristics of more severe MR indicated more symptoms, a lower quality of life and features of adverse cardiac remodelling -potentially a cause or result of volume overload, i.e. larger left ventricular and left atrial dimensions. Furthermore, patients with significant MR moreThe opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.