Functional mitral regurgitation at discharge and outcomes in patients hospitalized for acute decompensated heart failure with a preserved or reduced ejection fraction
Functional mitral regurgitation at discharge and outcomes in patients hospitalized for acute decompensated heart failure with a preserved or reduced ejection fraction
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DOI：
10.1002/ejhf.562
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发表时间：
2016-08-01
影响因子：
18.2
通讯作者：
Takano, Teruo
中科院分区：
文献类型：
--
作者：
Kajimoto, Katsuya;Sato, Naoki;Takano, Teruo
目的在急性失代偿性心力衰竭(HF)患者中，功能性二尖瓣返流(FMR)、左心室射血分数(EF)和预后之间的关系尚不清楚。本研究的目的是评估EF保留或减少的心衰患者的FMR与出院后预后的关系。方法和结果在急性失代偿性心力衰竭综合征(ADDY)登记的4842名患者中，3357名患者评估了出院时FMR(无、轻度或中/重度)、EF保留或减少以及主要终点(全因死亡率和心力衰竭再入院)之间的关系。出院后的中位随访期为530(387-800)天。多因素分析显示，保留EF组中轻度FMR和中/重度FMR患者达到终点的风险显著高于无FMR组[危险比(HR)1.40；95%可信区间(CI)1.14~1.72；P=0.001和HR 1.40；95%CI 1.09~1.81；P=0.009]。在EF降低组中，中、重度FMR患者的风险显著高于无FMR的患者(HR1.41；95%CI1.07-1.86；P=0.015)，但轻度FMR与到达终点的风险没有显著关联(HR1.09；95%CI0.84-1.42；结论在EF保留的HF患者中，即使轻度FMR也会增加不良结局的风险，而在EF降低的HF患者中，中度或重度FMR(但不是轻度FMR)与不良结局相关。
AimsThe relationship between functional mitral regurgitation (FMR), left ventricular ejection fraction (EF), and outcomes is unclear in acute decompensated heart failure (HF) patients. The aim of this study was to evaluate the relationship between FMR and post-discharge outcomes in HF patients with a preserved or reduced EF.Methods and resultsOf the 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 3357 patients were evaluated to assess the association among FMR (none, mild, or moderate/severe) at discharge, a preserved or reduced EF, and the primary endpoint (all-cause mortality and readmission for HF). The median follow-up period after discharge was 530 (387-800) days. According to multivariate analysis, patients with either mild FMR or moderate/severe FMR from the preserved EF group had a significantly higher risk of reaching the endpoint than patients without FMR [hazard ratio (HR) 1.40; 95% confidence interval (CI) 1.14-1.72; P = 0.001 and HR 1.40; 95% CI 1.09-1.81; P = 0.009, respectively]. In the reduced EF group, patients with moderate or severe FMR had a significantly higher risk relative to patients without FMR (HR 1.41; 95% CI 1.07-1.86; P = 0.015), but there was no significant association of mild FMR with the risk of reaching the endpoint (HR 1.09; 95% CI 0.84-1.42; P = 0.510).ConclusionOur findings demonstrate that even mild FMR is associated with an increased risk of adverse outcomes in HF patients with a preserved EF, while moderate or severe FMR (but not mild FMR) is associated with adverse outcomes in HF patients with a reduced EF.