Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure.
7 affiliations
- 1Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV, Carretera del Canyet s/n, Badalona 08916, Spain.
- 2Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, Barcelona 08035, Spain.
- 3Department of Cardiology, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Avenida Blasco Ibáñez 17, Valencia 46010, Spain.
- 4Department of Cardiology (CVK) of German Heart Center Charité, German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany.
- 5Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
- 6Baylor Scott and White Research Institute, Dallas, TX, USA.
- 7Division of cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
Background and aims
The prognostic significance of moderate secondary mitral regurgitation (MR) after optimized guideline-directed medical therapy (GDMT) in heart failure (HF) remains uncertain.Methods
We 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
The 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
In 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.
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BibTeX
@article{ferrero2026prognostic,
title = {{Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure.}},
author = {Cristina Ferrero and Pau Codina and Josep Lupón and María Ruiz-Cueto and Elisabet Zamora and Andrea Borrellas and Cinta Llibre and Clara Badia-Molins and Andrea Carrete and Evelyn Santiago-Vacas and Mar Domingo and Javier Santesmases and Elena Ferrer-Sistach and Claudia Escabia and Julio Núñez and Stefan D Anker and Marco Metra and Javed Butler and Gregg W Stone and Victoria Delgado and Antoni Bayes-Genis},
journal = {ESC heart failure},
year = {2026},
month = aug,
doi = {10.1093/eschf/xvag256},
url = {https://europepmc.org/article/MED/42888505},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure.
AU - Cristina Ferrero
AU - Pau Codina
AU - Josep Lupón
AU - María Ruiz-Cueto
AU - Elisabet Zamora
AU - Andrea Borrellas
AU - Cinta Llibre
AU - Clara Badia-Molins
AU - Andrea Carrete
AU - Evelyn Santiago-Vacas
AU - Mar Domingo
AU - Javier Santesmases
AU - Elena Ferrer-Sistach
AU - Claudia Escabia
AU - Julio Núñez
AU - Stefan D Anker
AU - Marco Metra
AU - Javed Butler
AU - Gregg W Stone
AU - Victoria Delgado
AU - Antoni Bayes-Genis
PY - 2026
DA - 2026/08/01
JO - ESC heart failure
DO - 10.1093/eschf/xvag256
UR - https://europepmc.org/article/MED/42888505
AB - Background and aims The prognostic significance of moderate secondary mitral regurgitation (MR) after optimized guideline-directed medical therapy (GDMT) in heart failure (HF) remains uncertain.Methods We 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 The 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 In 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.
SN - 2055-5822
ER -