{
  "abstract": "Background and aims\n\nThe prognostic significance of moderate secondary mitral regurgitation (MR) after optimized guideline-directed medical therapy (GDMT) in heart failure (HF) remains uncertain.Methods\n\nWe analysed 2468 ambulatory HF patients with paired transthoracic echocardiography at baseline and after 12 months of optimized GDMT. The primary composite was all-cause death or first heart failure hospitalization (HFH). Secondary endpoints included all-cause mortality and recurrent HFHs.Results\n\nThe mean age of patients was 66.2 ± 12.5 years, 70.6% were male, and the mean baseline left ventricular ejection fraction was 36.1% ± 13.6%. At 12 months, 80.5% of patients had no/mild MR, 15.6% had moderate MR, and 3.9% had severe MR. During a median 6.9-year follow-up, 1240 patients experienced the primary endpoint. Compared with no/mild MR, both moderate and severe MR at 12 months were independently associated with a higher risk of the primary composite endpoint [moderate: hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.47-1.95; severe: HR 1.81, 95% CI 1.44-2.29; both P < .001). Moderate MR was also independently associated with increased all-cause mortality (HR 1.54, 95% CI 1.32-1.79; P < .001) and recurrent HFHs (incidence rate ratio 2.17, 95% CI 1.81-2.60). Heart failure hospitalization rates were 9.03, 20.0, and 26.1 per 100 person-years in patients with no/mild, moderate, and severe MR, respectively. Among patients with moderate MR at 12 months, outcomes did not differ according to baseline MR severity.Conclusions\n\nIn this large-scale study, residual moderate secondary MR after 12 months of optimized GDMT was common and was independently associated with increased long-term mortality and HFHs.",
  "abstract_shown": true,
  "affiliations": [
    "Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV, Carretera del Canyet s/n, Badalona 08916, Spain.",
    "Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, Barcelona 08035, Spain.",
    "Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Avenida Blasco Ibáñez 17, Valencia 46010, Spain.",
    "Department of Cardiology (CVK) of German Heart Center Charité, German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany.",
    "Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.",
    "Baylor Scott and White Research Institute, Dallas, TX, USA.",
    "Division of cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Cristina Ferrero",
      "orcid": "0009-0000-8941-2631"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Pau Codina"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Josep Lupón"
    },
    {
      "affs": [
        0
      ],
      "name": "María Ruiz-Cueto"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Elisabet Zamora"
    },
    {
      "affs": [
        0
      ],
      "name": "Andrea Borrellas"
    },
    {
      "affs": [
        0
      ],
      "name": "Cinta Llibre"
    },
    {
      "affs": [
        0
      ],
      "name": "Clara Badia-Molins"
    },
    {
      "affs": [
        0
      ],
      "name": "Andrea Carrete"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Evelyn Santiago-Vacas"
    },
    {
      "affs": [
        0
      ],
      "name": "Mar Domingo"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Javier Santesmases"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Elena Ferrer-Sistach",
      "orcid": "0000-0002-1795-2193"
    },
    {
      "affs": [
        0
      ],
      "name": "Claudia Escabia"
    },
    {
      "affs": [
        2
      ],
      "name": "Julio Núñez",
      "orcid": "0000-0003-1672-7119"
    },
    {
      "affs": [
        3
      ],
      "name": "Stefan D Anker"
    },
    {
      "affs": [
        4
      ],
      "name": "Marco Metra"
    },
    {
      "affs": [
        5
      ],
      "name": "Javed Butler",
      "orcid": "0000-0001-7683-4720"
    },
    {
      "affs": [
        6
      ],
      "name": "Gregg W Stone"
    },
    {
      "affs": [
        0
      ],
      "name": "Victoria Delgado",
      "orcid": "0000-0002-9841-2737"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Antoni Bayes-Genis",
      "orcid": "0000-0002-3044-197X"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7pb2zwcn33692.bib",
  "cited_by": 0,
  "doi": "10.1093/eschf/xvag256",
  "fulltext_url": "https://europepmc.org/articles/PMC13695058",
  "id": "7pb2zwcn33692",
  "issns": [
    "2055-5822"
  ],
  "landing_url": "https://europepmc.org/article/MED/42888505",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": "https://europepmc.org/articles/PMC13695058?pdf=render",
  "pmcid": "PMC13695058",
  "pmid": "42888505",
  "published": "2026-08-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7pb2zwcn33692.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:18Z",
      "native_id": "MED:42888505",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42888505"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure.",
  "title_text": "Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:18Z",
  "url": "https://research.draconitic.com/paper/7pb2zwcn33692",
  "venue": "ESC heart failure",
  "versions": []
}