5 factors predict death in moderate/severe mitral regurgitation

Patients with moderate or severe mitral regurgitation who have been admitted for heart failure exacerbation or has an elevated right atrial pressure, renal dysfunction, anaemia, or lacks a mitral valve intervention suffer a greater risk of all-cause mortality, reveals a study.

The authors identified 490 patients with moderate or severe mitral regurgitation at a single centre from 1 January 2016 to 31 August 2017. They assessed variables independently associated with all-cause mortality through multivariable regression.

Of the patients (mean age 66.7 years, 50 percent male), 76.3 percent had moderate and 23.7 percent had severe mitral regurgitation due to primary (20.8 percent) or secondary (79.2 percent) aetiology. The incidence of all-cause mortality at a median follow-up of 3.1 years was 30.1 percent, while that of heart failure hospitalization and mitral valve intervention was 23.1 percent and 11.6 percent, respectively.

In multivariate analysis, five of the 117 variables independently predicted mortality: baseline creatinine (hazard ratio [HR], 1.2, 95 percent confidence interval [CI], 1.0‒1.3; p=0.02), right atrial pressure by echocardiogram (HR, 1.3, 95 percent CI, 1.07‒1.55; p=0.008), haemoglobin (HR, 0.65, 95 percent CI, 0.52‒0.83; p=0.001), hospitalization for heart failure (HR, 1.6, 95 percent CI, 1.1‒2.4; p=0.015), and mitral valve intervention (HR, 0.40, 95 percent CI, 0.16‒0.83; p=0.049).

Further studies are warranted to determine whether these risk factors could improve identification of patients who might benefit from more intensive monitoring or earlier intervention, the authors said.

“Mitral regurgitation is the most common form of valvular heart disease worldwide, [but] there is an incomplete understanding of predictors of mortality in this population,” they noted.