Prognostic comparison of atrial and ventricular functional mitral regurgitation

Chisato Okamoto, Atsushi Okada, Kunihiro Nishimura, Kenji Moriuchi, Masashi Amano, Hiroyuki Takahama, Makoto Amaki, Takuya Hasegawa, Hideaki Kanzaki, Tomoyuki Fujita, Junjiro Kobayashi, Satoshi Yasuda, Chisato Izumi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective Atrial functional mitral regurgitation (A-FMR) has been suggested as a new aetiology of functional MR (MR); however, its prognosis and prognostic predictors are not fully elucidated. Aim of this study was to investigate the prognosis and prognostic predictors of A-FMR in comparison with ventricular functional MR (V-FMR). Methods Three hundred and seventy-eight consecutive patients with moderate-to-severe or severe functional MR were studied. Functional MR was classified into V-FMR (N=288) and A-FMR (N=90) depending on the alterations of left ventricle (LV) or left atrium (LA) along with clinical context and diagnosis of ischaemic heart disease or cardiomyopathy. Results During a median follow-up of 4.1 (2.0-6.7) years, all-cause mortality, cardiovascular mortality and heart failure (HF) hospitalisation occurred in 98 (26%), 81 (21%) and 177 (47%) patients, respectively, and rates of these events and the composite end point of all-cause mortality and HF hospitalisation were consistently higher in V-FMR than A-FMR (unadjusted HR 1.762 (95% CI 1.250 to 2.438), p<0.001; adjusted HR 1.654 (95% CI 1.027 to 2.664), p=0.038, for the composite end point). Further analysis showed different prognostic predictors between V-FMR and A-FMR; while age and LA volume index were independent prognostic predictors of both V-FMR and A-FMR, systolic blood pressure and B-type natriuretic peptide were also those of V-FMR, and estimated glomerular filtration rate, LV end-systolic dimension and tricuspid regurgitation were also those of A-FMR. Conclusions The prognosis of V-FMR was significantly worse than that of A-FMR, and prognostic predictors were different between V-FMR and A-FMR. Our study suggests the importance of discriminating A-FMR and V-FMR, and that different treatment strategies may be considered for each aetiology.

Original languageEnglish
Article numbere001574
JournalOpen Heart
Volume8
Issue number1
DOIs
Publication statusPublished - 2021 Feb 15
Externally publishedYes

Keywords

  • Echocardiography
  • Heart failure
  • Mitral regurgitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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