Elsevier

JACC: Heart Failure

Volume 9, Issue 3, March 2021, Pages 179-189
JACC: Heart Failure

Clinical Research
Prevalence and Prognostic Significance of Mitral Regurgitation in Acute Decompensated Heart Failure: The ARIC Study

https://doi.org/10.1016/j.jchf.2020.09.015Get rights and content
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Abstract

Objectives

This study investigates the prevalence and prognostic significance of mitral regurgitation (MR) in acute decompensated heart failure (ADHF) patients.

Background

Few studies characterize the burden of MR in heart failure.

Methods

The ARIC (Atherosclerosis Risk In Communities) study surveilled ADHF hospitalizations for residents ≥55 years of age in 4 U.S. communities. ADHF cases were stratified by left ventricular ejection fraction (LVEF): <50% and ≥50%. Odds of moderate or severe MR in patients with varying sex and race, and odds of 1-year mortality in those with higher MR severity were estimated using multivariable logistic regression.

Results

From 2005 to 2014, there were 17,931 weighted ADHF hospitalizations of which 49.2% had an LVEF <50% and 50.8% an LVEF ≥50%. Moderate or severe MR prevalence was 44.5% in those with an LVEF <50% and 27.5% in those with an LVEF ≥50%. Moderate or severe MR was more likely in females than males regardless 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]). Among hospitalizations with an LVEF ≥50%, moderate or severe MR was less likely in blacks than whites (OR: 0.72 [95% CI: 0.64 to 0.82]). Higher MR severity was independently associated with increased 1-year mortality in those with an LVEF <50% (OR: 1.30 [95% CI: 1.16 to 1.45]).

Conclusions

Patients with ADHF have a significant MR burden that varies with sex and race. In ADHF patients with an LVEF <50%, higher MR severity is associated with excess 1-year mortality.

Key Words

ADHF
Atherosclerosis Risk In Communities study
HF
mortality
MR

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
ADHF
acute decompensated heart failure
ARB
angiotensin receptor blocker
ARIC
Atherosclerosis Risk in Communities
CI
confidence interval
HF
heart failure
LVEF
left ventricular ejection fraction
MR
mitral regurgitation
OR
odds ratio

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Drs. Arora and Sivaraj contributed equally to this work.