Iranian Heart Journal

Iranian Heart Journal

Long-term Adverse Events of Nonischemic Functional Mitral Regurgitation in Patients With Heart Failure

Document Type : Original Article

Authors
Saeid Hosseini 1
Zeinab Nazari 2
Ali Rafati 1
Yeganeh Pasebani 1
Nasim Naderi 2
Ahmad Amini 2
Alireza Alizadeh Ghavidel 2
Mona Yadollahi 2
Mohammad Mehdi Peighambari 2
Sepideh Taghavi 2
1 Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Nonischemic functional mitral regurgitation (FMR) is accompanied by dire long-term consequences. The treatment revolves around correcting the underlying left ventricular dysfunction. This study reports the long-term adverse outcomes of nonischemic FMR.
 
Methods: We enrolled 200 patients with at-least-moderate nonischemic FMR undergoing medical treatment and/or cardiac resynchronization therapy between 2003 and 2019. MR severity and left ventricular dysfunction parameters were obtained. The endpoint outcomes were all-cause mortality, stroke, all-cause rehospitalization, and the need for heart transplantation.
 
Results: Two hundred participants, 104 men (52%) and 96 women (48%), with a median age of 61 years (interquartile range [IQR], 50-70) at diagnosis and a median follow-up of 2 years (IQR, 1-4), were enrolled. All-cause mortality, all-cause rehospitalization, and need for heart transplantation were significantly associated with lower left ventricular ejection fraction and tricuspid annular plane systolic excursion (TAPSE) at diagnosis (P < 0.05). Baseline MR severity was significantly associated with stroke (P = 0.026) and all-cause rehospitalization (P < 0.001).
MR severity, New York Heart Association (NYHA) classification, left ventricular end-diastolic diameter, and TAPSE improved at follow-up (P < 0.001). ACEi/ARB (P = 0.008), nitrate (P = 0.001), and hydralazine (P = 0.006) were associated with MR severity improvement. A significant difference was observed between survival free of all-cause mortality according to left ventricular ejection fraction (P = 0.041).
 
Conclusions: We reported freedom from all-cause mortality, cardiac mortality, and composite endpoints (all-cause mortality, heart transplantation, and stroke) in nonischemic FMR patients. We detected a significant decline in MR severity and NYHA classification during follow-up. Overall, the FMR-associated mortality risk can be significantly reduced by adhering to treatment guidelines in a tertiary heart center. (Iranian Heart Journal 2024; 25(1): 27-41)
Keywords
Nonischemic functional mitral regurgitation
MR severity
NYHA classification
Heart failure
CRT
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Iranian Heart Journal
Volume 25, Issue 1
Winter 2024
Pages 27-41