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Prognostic significance of residual functional mitral regurgitation in hospitalized heart failure patients with chronic atrial fibrillation and preserved ejection fraction after medical therapies

  • Kazato Ito
  • Yukio AbeEmail author
  • Hiroyuki Watanabe
  • Yoshihisa Shimada
  • Kentaro Shibayama
  • Hiroki Oe
  • Eiichi Hyodo
  • Chinami Miyazaki
  • Yosuke Takahashi
  • Toshihiko Shibata
  • Hiroshi Ito
Original Investigation
  • 26 Downloads

Abstract

Background

Functional mitral regurgitation (MR) can be seen in patients with atrial fibrillation (AF), even without left-ventricular (LV) systolic dysfunction, as a result of left atrial enlargement. The purpose of this study was to evaluate the prognostic significance of residual functional MR in hospitalized heart failure patients with chronic AF and preserved LV ejection fraction (pEF) after medical therapies.

Methods

In this retrospective multi-center study, the determinants of post-discharge prognosis (cardiac death and re-hospitalization for worsening heart failure) were examined in 54 hospitalized heart failure patients with chronic AF and pEF at discharge.

Results

Of the 54 patients, 53 (98%) had mild or higher degrees of functional MR at hospitalization.At discharge, 47 (87%) still had functional MR, even after medical therapies [mild in 27 (50%), moderate in 16 (30%), and severe in 4 (7%)]. During the follow-up period (20 ± 16 months) after discharge, 16 (30%) patients met the composite end points. The grading of residual functional MR at discharge was the significant predictor of the end point (hazard ratio per one grade increase: 2.4, 95% confidence interval 1.1–5.5, p = 0.035). The greater the residual functional MR was, the lower the event-free rate from the end point was in the Kaplan–Meier curve analysis (p = 0.0069 for trend).

Conclusions

A substantial proportion of patients hospitalized due to heart failure with chronic AF have residual functional MR at discharge, even with pEF after medical therapies, and the MR is related to future heart failure events.

Keywords

Atrial fibrillation Echocardiography Heart failure Mitral regurgitation 

Notes

Compliance with ethical standards

Conflict of interest

Kazato Ito, Yukio Abe, Hiroyuki Watanabe, Yoshihisa Shimada, Kentaro Shibayama, Hiroki Oe, Eiichi Hyodo, Chinami Miyazaki, Yosuke Takahashi, Toshihiko Shibata, and Hiroshi Ito declare that they have no conflict of interest.

Human rights statements

Human rights statements and informed consent: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  • Kazato Ito
    • 1
  • Yukio Abe
    • 2
    Email author
  • Hiroyuki Watanabe
    • 3
  • Yoshihisa Shimada
    • 1
  • Kentaro Shibayama
    • 3
  • Hiroki Oe
    • 4
  • Eiichi Hyodo
    • 5
  • Chinami Miyazaki
    • 6
  • Yosuke Takahashi
    • 7
  • Toshihiko Shibata
    • 7
  • Hiroshi Ito
    • 4
  1. 1.Cardiovascular CenterShiroyama HospitalHabikinoJapan
  2. 2.Department of CardiologyOsaka City General HospitalOsaka CityJapan
  3. 3.Department of CardiologyTokyo Bay Urayasu/Ichikawa Medical CenterUrayasuJapan
  4. 4.Department of Cardiovascular MedicineOkayama UniversityOkayamaJapan
  5. 5.Department of CardiologyNishinomiya-Watanabe Cardiovascular CenterNishinomiyaJapan
  6. 6.Department of CardiologyHigashisumiyioshi Morimoto HospitalOsakaJapan
  7. 7.Department of Cardiovascular SurgeryOsaka City University Graduate School of MedicineOsakaJapan

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