Mitral regurgitation and all-cause mortality in acute heart failure: a meta-analysis.
Max Berrill, Meric Bengisu, Konstantina Kipourou et al.
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In 30 seconds
This meta-analysis examined the association between mitral regurgitation (MR) and all-cause mortality in acute heart failure (AHF), pooling 27 studies with 73 363 patients and an average follow-up of 1.9 years. Moderate/severe MR was associated with higher mortality than no/mild MR: unadjusted odds ratio (OR) 1.47 (95% CI 1.30-1.66, P < .001). The association persisted in studies reporting adjusted results (OR 1.21 [95% CI 1.01-1.45, P = .038]). The authors note that the observational evidence and substantial between-study heterogeneity preclude causal conclusions.
Key findings
- Moderate/severe MR was associated with higher mortality than no/mild MR: OR 1.47 (95% CI 1.30-1.66, P < .001).
- In studies reporting adjusted data, the association remained: OR 1.21 (95% CI 1.01-1.45, P = .038).
- Compared with no MR, mortality odds increased with moderate MR (OR 1.48 [95% CI 1.1-2.01, P = .011]) and severe MR (OR 1.60 [95% CI 1.13-2.27, P = .008]); mild MR was not significantly associated.
- For moderate/severe MR versus no/mild MR, excess mortality was observed with LVEF < 50% and LVEF 40-50%, but not LVEF >50%.
Why it matters
MR severity may help identify AHF patients with a higher observed risk of death, including those with reduced or mildly reduced LVEF. The findings support attention to MR as a prognostic feature in decompensated heart failure, while the observational design means they do not establish that MR causes the excess mortality or that treating it improves outcomes.
What to keep in mind
The included studies were observational and showed substantial heterogeneity, limiting causal inference and consistency of the pooled estimates.