86 Mitral regurgitation in acute heart failure: prevalence and response to treatment

Abstract

Heart failure (HF) affects an estimated 90 000 people within the UK and 26 million worldwide. As a consequence of ventricular remodelling, significant mitral regurgitation (MR) is common in patients with HF, further contributing to poor prognosis, frequent hospitalisation, and higher rates of mortality. Conventional treatment options for HF patients with MR include medical therapy, cardiac resynchronisation and conventional mitral valve surgery, with transcatheter mitral valve repair reserved for symptomatic patients with left ventricular dysfunction and multiple comorbidities, considered high surgical risk. Aim Our objectives were to determine: (1) the proportion of patients with an acute HF admission, an EF of Method We performed a retrospective analysis of all patients who presented with acute HF to two large London based tertiary centres over a five year period. Based on a combination of electronic care records, national registry data, and UK Office of National Statistics (ONS) mortality data, we determined baseline symptoms, symptom progression, and co-morbidities. Echocardiography data was used to assess the degree of MR and left ventricular systolic function (EF). Where patients underwent subsequent echocardiographic examinations on maximally tolerated medical therapy, the change in the degree of mitral regurgitation, ejection fraction and symptoms (NYHA class) was examined. Logistic regression was used to assess the impact of age, EF and comorbidities. Results Over a five-year period (Jan 2012 – Dec 2017), 1884 patients presented with acute HF. Of this cohort, 302 (16%) had moderate or more MR and an EF of Conclusions A large portion of patients who present with acute heart failure have moderate or more MR. Although medical therapy is effective in providing some relief from symptoms, the large majority of patients continue to have moderate or more mitral regurgitation. We propose a portion of these patients are potential candidates for transcatheter mitral valve repair according to current international guidelines, and should be considered for further intervention. Conflict of Interest Nil