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Impact of functional mitral regurgitation on outcomes following cardiac resynchronization therapy for heart failure
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 11 – AVANÇOS NA GESTÃO DA INSUFICIÊNCIA CARDÍACA
Speaker:
Isabel Moreira
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Isabel Martins Moreira; Marta Catarina Bernardo; Luís Sousa Azevedo; Isabel Nóbrega Fernandes; José P. Guimarães; Sílvia Leão; Renato Margato; José Paulo Fontes; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong> Functional mitral regurgitation (FMR) is common in heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT). Although CRT can improve FMR, the long-term evolution and prognostic significance of FMR post-CRT remain unclear.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> This study aims to evaluate the prevalence, evolution, and prognostic impact of FMR in HF patients undergoing CRT.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> We conducted a single-center retrospective study of consecutive patients who underwent CRT implantation between January 2017 and April 2024. Echocardiographic assessments were performed at baseline and 6-12 months post-CRT. FMR severity was classified as mild, moderate or severe, according to quantitative and qualitative methods, and FMR improvement was defined as a reduction of ≥1 grade in MR class. Patients with a ≥15% reduction in left ventricle end-systolic volume (LVESV) or a ≥10% increase in left ventricle ejection fraction (LVEF) were considered responders to CRT. The primary endpoint was major adverse cardiac events (MACE), including cardiovascular mortality or HF hospitalization.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> A total of 206 patients (median age 74 [IQR 66-79] years, 68.4% male, 67.5% non-ischemic etiology, 88.7% NYHA class II-III) were evaluated. At baseline, FMR was present in 152 patients (55,3% mild, 34,2% moderate, 10,5% severe), with a total of 68 patients having significant FMR (moderate or severe). Significant FMR was more common in older patients (74.0 vs 71.5 years, p=0.012) and women (54.9% vs 36.0%, p=0.024). At 1-year follow-up, FMR improved in 59.6% of patients with significant FMR. As expected, these patients exhibited better CRT response (90.3% vs 60.0%, p=0.015), lower LVESV (65 [43-96] ml vs 128 [101-169] ml) and lower proBNP levels (567 [277-1692] pg/mL vs 4071 [1203-9351] pg/mL, p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">During a mean follow-up of 35±24 months, 18 (8.7%) patients died from cardiovascular causes and 44 (21.4%) experienced MACE. Persistent significant FMR post-CRT was associated with an increased risk of MACE, after adjusting for CRT response (HR: 4.369, 95% CI 1.425–13.398, p=0.01).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong>: In this study, 59.6% of patients experienced FMR improvement, which correlated with better therapeutic response and prognosis. In contrast, persistent significant FMR post-CRT was associated with a higher incidence of MACE, regardless of CRT responsiveness. These findings highlight the need for closer follow-up and the importance of considering valvular interventions in patients with persistent FMR post-CRT.</span></span></p>
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