The Prognostic Role of Mitral Valve Regurgitation Severity and Left Ventricle Function in Acute Heart Failure

Aims: Data about the prognostic interplay between mitral regurgitation MR and left ventricular (LV) function in the outcome of patients admitted with acute heart failure (AHF) are scarce. We evaluated the prognostic impact of MR severity and LV function on mortality and on recurrent heart failure hospitalization (re-HFH) in patients admitted with AHF. Methods and Results: In total, 6843 patients admitted with AHF were evaluated: 2521 patients with LV ejection fraction (LVEF) <= 40% (reduced LVEF), 1238 of them (51%) having >= moderate MR; and 4322 with LVEF > 40% (preserved LVEF), 1175 of them (27%) having >= moderate MR. One-year mortality and re-HFH rates were higher in patients with >= moderate MR unrelated to the baseline LV function (p = 0.028 and p < 0.001, respectively). After multivariable analysis, only reduced LVEF, and not the severity of MR, predicted mortality risk (HR: 1.31 [95% CI: 1.12-1.53] for patients with reduced LV function and <= mild MR; HR: 1.44 [95% CI: 1.25-1.67] for patients with reduced LV function and >= moderate MR); p < 0.001 for both. There was an increased risk for re-HFH in each group (HR: 1.35 [95% CI: 1.17-1.52] for patients with preserved LV function and >= moderate MR; HR: 1.31 [95% CI: 1.15-1.51] for patients with reduced LV function and mild MR; and HR: 1.65 [95% CI: 1.45-1.88] for patients with reduced LV function and >= moderate MR); p < 0.001 for all. Conclusions: In patients admitted with AHF, the LV function is the main prognostic determinant for mortality after 1 year. Significant (>= moderate) MR is associated with an increased risk of recurrent hospitalization.