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Functional Mitral Regurgitation in Advanced Heart Failure
Session:
Posters (Sessão 4 - Écran 4) - Insuficiência Cardíaca 4 - Vários 2
Speaker:
Bárbara Lacerda Teixeira
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Bárbara Lacerda Teixeira; João Ferreira Reis; António Gonçalves; Rita Ilhão Moreira; Tiago Pereira Silva; Ana Teresa Timóteo; Pedro Rio; Pedro Brás; Vera Ferreira; Alexandra Castelo; Ana Sofia Jacinto; Ana Rita Teixeira; Tânia Branco Mano; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Cambria,serif"><span style="color:black">Introduction: </span></span></span></strong><span style="font-size:12pt"><span style="font-family:Cambria,serif"><span style="color:black">Moderate-to-severe functional mitral regurgitation (fMR) is present in about one-third of patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) and contributes to progression of the symptoms of HF and is an independent predictor of worse clinical outcomes.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Cambria,serif"><span style="color:black">Objective: </span></span></span></strong><span style="font-size:12pt"><span style="font-family:Cambria,serif"><span style="color:black">To characterize the population of advanced HF patients with severe FMR in a tertiary center and assess its prognostic impact.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">Methods: </span></span></strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">Prospective evaluation of adult patients with advanced HFrEF were referred to a single tertiary center for evaluation with HF team and possible indication for urgent heart transplantation (HT) or mechanical circulatory support (MCS). <span style="color:black">Patients</span> were followed up for 1 year for the primary endpoint of cardiac death and HT. S<span style="color:black">evere FMR was defined by an EROA ≥ 20 mm2 and/or a regurgitant volume (RVol) ≥ 30 mL either taken from TTE or TOE. </span>A survival analysis was performed to evaluate the prognostic impact of fMR and survival curves were compared using the log-rank test.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">Results: </span></span></strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">A total of 450 <span style="color:black">HFrEF</span> patients (</span></span><span style="font-size:12pt"><span style="font-family:Cambria,serif">mean age of 56±12 years, 80% male, mean LVEF of 29±4%) of which 14.4% had severe fMR, with a mean EROA of 29.2±3.1 mm<sup>2</sup> and a mean <span style="color:black">RVol of 43.6</span>±4.7<span style="color:black"> mL</span>. Thirty patients (6.7%) met the primary endpoint. Patients with severe fMR were more likely to be female (69.2% vs 81.5%, p = 0.026) and to have atrial fibrillation (27.0% vs 14.1%, p = 0.028), had a higher NT-proBNP value (3625.8±496.9 vs 1940±212.4 pg/mL, p = 0.001), a lower LVEF (25.9±6.8 vs 29.0±6.7, p = 0.001), more dilated LV (LV end-diastolic diameter: 72.8±13.3 vs 66.9±9.0 P = 0.036), a lower HFSS value (8.1±1.0 vs 8.6±1.0). There was no difference regarding HF etiology, NYHA class or cardiopulmonary fitness (pVO<sub>2</sub>: 16.6±5.6 vs 16.5±6.3 ml/kg/min, p = 0.19; VE/VCO<sub>2</sub> slope: 35.4±9.9 vs 34.0±9.7, p = 0.328). EROA was an independent predictor of the primary outcome (OR 1.23, 95% CI 1.08-1.54, p = 0.039). Patients with severe fMR had a lower survival free of events during the first follow-up year (log-rank p = 0.012)(Image 1).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">Conclusion: </span></span></strong><span style="font-size:12pt"><span style="font-family:Cambria,serif">Severe fMR is a common complication of HF, and is more prevalent as disease progresses. Increasing severity of fMR is associated with a stepwise increase in mortality. Severe fMR is an independent predictor of poor prognosis</span></span><span style="font-size:12pt"><span style="font-family:Cambria,serif">. </span></span></span></span></span></p>
Slides
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