The ARIC Study: Prevalence and Prognosis of Mitral Regurgitation in ADHF Patients

23 Mar, 21

Introduction

Studies have demonstrated an association between mitral regurgitation (MR) and decreased survival in patients with acute decompensated heart failure (ADHF). Moderate to severe MR may also predict mortality in acute and chronic HF patients. Only few studies have characterized the burden of MR in HF till date. Mitral regurgitation being an emerging therapeutic target in HF, characterizing the burden of MR in real world setting is essential.

Aim

To determine the prevalence and prognostic significance of MR in ADHF patients

Patient Profile

Participants from the ARIC (Atherosclerosis Risk In Communities) study: patients survielled for ADHF hospitalizations (age ≥55 years; n=3878)
Patients were stratified by left ventricular ejection fraction (LVEF) as: <50% and ≥50%

Methods

Study Design

A sub-study of ARIC study
ARIC was a prospective cohort study

Outcomes

Odds of moderate or severe MR in patients with varying gender and race
Odds of 1-year mortality in those with higher MR severity

Results

Overall, 17,931 weighted ADHF hospitalizations occurred during years 2005-2014. Of these, 49.2% patients had an LVEF <50% and 50.8% had an LVEF ≥50%. The prevalence of moderate or severe MR was higher in patients with LVEF <50% vs. those with an LVEF ≥50% (44.5% vs. 27.5%).
Females rather than males were more likely to have moderate or severe MR, irrespective of LVEF; LVEF <50% (odds ratio [OR]: 1.21; 95% confidence interval [CI]: 1.11 to 1.33), LVEF ≥50% (OR: 1.52; 95% CI: 1.36 to 1.69).
Amongst hospitalized patients with an LVEF ≥50%, moderate or severe MR was less likely in blacks vs. whites (OR: 0.72; 95% CI: 0.64 to 0.82).
All-cause 1-year mortality after ADHF hospitalization was slightly higher in patients with an LVEF <50% vs. those with an LVEF ≥50% (31.3% vs. 28.0%). As per a multivariable regression analysis, higher MR severity was independently associated with increased 1-year mortality in patients with an LVEF <50% (OR: 1.30; 95% CI: 1.16 to 1.45).

Conclusions

Patients with ADHF bear a substantial burden of MR. This burden varied with gender and race, with females rather than males being more likely to have moderate to severe MR, irrespective of LVEF. Similarly, moderate to severe MR was likely in whites rather than blacks
Amongst ADHF patients with an LVEF <50%, higher MR severity was associated with higher 1-year mortality.
Future studies that would better characterize the HF population at risk for MR and would improve the management of MR in this high-risk population are warranted.

JACC Heart Fail. 2021 Mar;9(3):179-189.