Research Article
Volume 7 Issue 10 - 2020
Secondary Mitral Regurgitation Impact on Symptoms and Prognosis in a Moroccan Population of Heart Failure with Reduced Ejection Fraction Patients
Meryem Haboub*, H Mechal, M Elmoussaid, MA Boutaleb, K Mounaouir, ME Benouna, A Drighil, L Azzouzi and R Habbal
Department of Cardiology, Hospital University Ibn Rochd, Casablanca, Morocco
*Corresponding Author: Meryem Haboub, Department of Cardiology, Hospital University Ibn Rochd, Casablanca, Morocco.
Received: July 12, 2020; Published: September 30, 2020




Abstract

Introduction: Secondary mitral regurgitation (SMR) occurs in 20% to 30% of patients with heart failure and reduced left ventricular ejection fraction (HFrEF). There is conflicting evidence regarding its prognostic significance. The aim of this study is to report the impact of SMR on Moroccan HFrEF patients symptoms and prognosis.

Methods: Transversal retrospective study conducted between May 2006 and June 2019 including all patients with HFrEF, followed-up in the therapeutic unit of HF of our department. We studied 2 groups of patients: group 1 with SMR and group 2 without SMR. Data were collected on Excel and analyzed using SPSS 2.0 software. Differences were considered statistically significant when p < 0.05.

Results: Among 3412 patients, 42.6% had SMR. Mean age was 66.68 ± 12.78 years in group 1 versus 63.86 ± 12.62 years in group 2 (p < 0.001). History of arterial hypertension in 40.4% versus 38.5% (p < 0.001), diabetes mellitus in 30.8% versus 32.3% (p < 0.001), tobacco use in 30.2% versus 37.6% (p < 0.001). Regarding etiologies: ischemic heart disease in 54.5% versus 63.5% (p < 0.001). Regarding NYHA functional class: class I in 11.7% versus 22%, class II in 59.8% versus 60.5%, class III in 26.5% versus 15.5%, class IV in 2.1% versus 2% (p < 0.001). Signs of left HF in 11.2% versus 6.8% (p < 0.001), signs of right HF in 8.8% versus 4.2% (p < 0.001), mean HR was 79.39 ± 16.82 bpm versus 76.07 ± 16.72 bpm (p < 0.001). Persistent atrial fibrillation was present in 13.1% versus 9.4% (p < 0.001). Echocardiographic data: mean LVEF was 34.69 ± 13.19% versus 33.90 ± 14.19% (p = 0.488), mean LVEDD was 59.21 ± 9.33 mm versus 56.12 ± 8.21 mm (p < 0.001), elevated left ventricle filling pressures in 26.7% versus 16.8% (p < 0.001), SPAP was 39.20 ± 15.17 mmHg versus 35.16 ± 15.74 mmHg (p < 0.001), significant functional tricuspid regurgitation in 12.6% versus 3.9% (p < 0.001), RV systolic longitudinal dysfunction in 47.6% versus 40.8% (p < 0.001). HF hospitalization rates were 29.6% versus 20.3% (p < 0.001). Mortality rates were 3.1% versus 1.5% (p = 0.012).

Conclusion: In patients with HFrEF, SMR impacts NYHA functional class, and is associated with hospitalisation for HF and mortality.

Keywords: Secondary Mitral Regurgitation; Heart Failure with Reduced Ejection Fraction; NYHA Functional Class; Hospitalisation for Heart Failure; Mortality

References

  1. Anna Sannino, Survival and Cardiovascular Outcomes of Patients with Secondary Mitral Regurgitation: A Systematic Review and Meta-analysis”. JAMA Cardiology 10 (2017): 1130-1139.
  2. Hung J., et al. “Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target”. Circulation 110 (2004): 1185-1190.
  3. Rossi A., et al. “Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1,256 patients with ischaemic and non-ischaemic dilated cardiomyopathy”. Heart 97 (2011): 1675-1680.
  4. Patel JB., et al. “Mitral regurgitation in patients with advanced systolic heart failure”. Journal of Cardiac Failure 4 (2004): 285-291.
  5. Boriani G., et al. “InSync/InSync ICD Italian Registry Investigators. Impact of mitral regurgitation on the outcome of patients treated with CRT-D: data from the InSync ICD Italian Registry”. Pacing and Clinical Electrophysiology 2 (2012): 146-154.
  6. Grande-Allen KJ., et al. “Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements: an extracellular matrix and echocardiographic study”. Journal of the American College of Cardiology 45 (2005): 54-61.
  7. Chaput M., et al. “Leducq Foundation MITRAL Transatlantic Network: Mitral leaflet adaptation to ventricular remodeling: prospective changes in a model of ischemic mitral regurgitation”. Circulation 120 (2009): S99-S103.
  8. Agricola E., et al. “Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern”. European Journal of Echocardiography 5 (2004): 326-334.
  9. Magne J., et al. “Ischemic mitral regurgitation: a complex multifaceted disease”. Cardiology 112 (2009): 244-259.
  10. Lancellotti P., et al. “European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2. Mitral and tricuspid regurgitation (native valve disease)”. European Journal of Echocardiography 11 (2010): 307-332.
  11. Pu M. “The frequency, impact, and management of mitral regurgitation in patients with heart failure”. Current Cardiology Reports 8 (2006): 226-231.
  12. Garcı´a-Cosı´o Carmena MD., et al. “Prognostic Implications of Functional Mitral Regurgitation in Patients With Heart Failure and Reduced Ejection Fraction”. Revista Española de Cardiología (2017).
  13. Martens P., et al. “The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction”. Cardiovascular Therapeutics 36 (2018): e12435.
  14. Nasser R., et al. “Evolution of functional mitral regurgitation and prognosis in medically managed heart failure patients with reduced ejection fraction”. Journal of the American College of Cardiology 5 (2017): 652-659.
  15. Stolfo D., et al. “Early improvement of functional mitral regurgitation in patients with idiopathic dilated cardiomyopathy”. The American Journal of Cardiology 115 (2015): 1137-1143.
  16. Obadia JF., et al. “Percutaneous repair or medical treatment for secondary mitral regurgitation”. The New England Journal of Medicine (2018).
  17. Stone GW., et al. “For the COAPT Investigators. Transcatheter mitral valve repair in patients with heart failure”. The New England Journal of Medicine (2018).
  18. Paul A Grayburn. “Proportionate and Disproportionate Functional Mitral Regurgitation A New Conceptual Framework That Reconciles the Results of the MITRA-FR and COAPT Trials”. JACC (2018).
Citation: Meryem Haboub., et al. “Secondary Mitral Regurgitation Impact on Symptoms and Prognosis in a Moroccan Population of Heart Failure with Reduced Ejection Fraction Patients”. EC Cardiology 7.10 (2020): 48-53.

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