Clinical Course and Outcomes of Acute Heart Failure with Moderate-to-Severe Mitral or Tricuspid Regurgitation: Decongestion in Heart Failure with Atrioventricular Valve Regurgitation

Abstract

Moderate-to-severe mitral regurgitation (MR) and tricuspid regurgitation (TR) are common in patients hospitalized with heart failure (HF) and have been associated with poor quality of life and increased mortality. The impact of these valve lesions on in-hospital decongestion and post-discharge outcomes is less clear. This study analyzed 617 patients hospitalized for acute HF in the DOSE-AHF, ROSE-AHF, and CARESS-HF trials. We assessed biomarkers, physical exam findings, and symptom scores in 288 patients without moderate-to-severe regurgitation, 221 patients with moderate-to-severe MR, and 242 patients with moderate-to-severe TR to evaluate decongestion efficacy and outcomes. For patients with moderate-to-severe MR, there was no difference in weight loss, net fluid loss, or change in creatinine compared to those without moderate-to-severe regurgitation (all: p > 0.05 at 72h). For patients with moderate-to-severe TR, there was more weight loss (-4.77 lbs vs -2.83 lbs at 24 h, p = 0.029; -9.32 lbs vs -6.99 lbs at 72 h, p = 0.007), net fluid loss (-4988mL vs -4581mL, p = 0.008) and improvement in creatinine (-0.09 mg/dl vs +0.06 mg/dl at 72 h, p = 0.002) compared to those without moderate-to-severe regurgitation. Among those with and without moderate-to-severe regurgitation, there was no difference in the change in patient-reported dyspnea or global well-being (all: p > 0.05 at 72 h or 96 h). For post-discharge outcomes, compared to patients without moderate-to-severe regurgitation, moderate-to-severe MR was associated with a non-significant trend towards increased death, rehospitalization, or unscheduled clinic or emergency department visit 60 days following hospital discharge (48.4% vs 38.2% of patients; p = 0.098). This association was not clearly apparent in patients with moderate-to-severe TR (43.8% vs 38.2%, p = 0.407). In conclusion, patients with moderate-to-severe MR experienced similar in-hospital decongestion compared with those without significant regurgitation but had a trend towards worse post-discharge outcomes. Patients with moderate-to-severe TR experienced significantly more decongestion but this was not associated with incremental improvement in dyspnea, global well-being, or clinical outcomes.