Data_Sheet_1.docx

Abstract

Objectives: To assess the prevalence and impact of MR on survival in patients presenting to hospital in AHF using traditional echocardiographic assessment alongside more novel indices of proportionality. Background It remains unclear if the severity of mitral regurgitation (MR) plays a significant role in determining outcomes in acute heart failure (AHF). There is also uncertainty as to the clinical relevance of indexing MR to left ventricular volumes. This concept of disproportionality has not been assessed in AHF. Methods 418 consecutive patients presenting in AHF over 12 months were recruited and followed up for 2 years. MR was quantitatively assessed within 24 hours of recruitment. Standard proximal isovelocity surface area (PISA) and a novel proportionality index of effective regurgitant orifice/left ventricular end-diastolic volume (ERO/LVEDV) >0.14mm2/ml were used to identify severe and disproportionate MR. Results: Every patient had MR. 331/418 (78.9%) were quantifiable by PISA. 165/418 (39.5%) displayed significant MR. A larger cohort displayed disproportionate MR defined by either a proportionality index using ERO/LVEDV >0.14 mm2/ml or regurgitant volumes/LVEDV >0.2 (217/331 (65.6%) and 222/345 (64.3%) respectively). The LVEDV was enlarged in significant MR - 129.5±58.95ml vs. 100.0±49.91ml in mild, [p0.14 mm2/ml was also associated with worse outcome (42.4% vs. 28.3% [HR 1.62; 95% CI 1.12-2.34, p=0.01]). Conclusions MR was a universal feature in AHF and determines outcome in significant cases. Furthermore, disproportionate MR, defined either by EROA or volumetrically, is associated with worse prognosis despite the absence of adverse LV remodelling. These findings outline the importance of adjusting acute volume overload to LV volumes and calls for a review of the current standards of MR assessment. Trial registration number: NCT02728739. https://clinicaltrials.gov/ct2/show/NCT02728739