BackgroundReduction in degree of mitral regurgitation (MR), accompanied by forward redistribution of MR flow, is one of the main mechanisms responsible for augmented cardiac output during treatment of acute decompensated heart failure (ADHF).HypothesisWe entertained the hypothesis that different MR mechanisms at baseline, as judged by jet direction, influence hemodynamic or echocardiographic response to therapy or prognosis.MethodsSixty-nine ADHF patients, admitted for hemodynamically tailored therapy and with available baseline and follow-up echocardiogram, were dichotomized according to the MR jet direction (central vs. eccentric). Baseline demographic, hemodynamic and echocardiographic characteristics were compared in addition to hemodynamic and echocardiographic response to therapy after 48 hours. Death, transplantation and rehospitalization were used as a combined endpoint.ResultsConclusionsDespite differences at baseline, MR mechanism, as adjudicated by jet direction, does not seem to influence hemodynamic or echocardiographic response during tailored therapy, nor prognosis. This suggests that improvement in leaflet coaptation and reduction in effective regurgitant orifice by intensive medical therapy occur to a same degree in either MR mechanisms. BackgroundReduction in degree of mitral regurgitation (MR), accompanied by forward redistribution of MR flow, is one of the main mechanisms responsible for augmented cardiac output during treatment of acute decompensated heart failure (ADHF). Reduction in degree of mitral regurgitation (MR), accompanied by forward redistribution of MR flow, is one of the main mechanisms responsible for augmented cardiac output during treatment of acute decompensated heart failure (ADHF). HypothesisWe entertained the hypothesis that different MR mechanisms at baseline, as judged by jet direction, influence hemodynamic or echocardiographic response to therapy or prognosis. We entertained the hypothesis that different MR mechanisms at baseline, as judged by jet direction, influence hemodynamic or echocardiographic response to therapy or prognosis. MethodsSixty-nine ADHF patients, admitted for hemodynamically tailored therapy and with available baseline and follow-up echocardiogram, were dichotomized according to the MR jet direction (central vs. eccentric). Baseline demographic, hemodynamic and echocardiographic characteristics were compared in addition to hemodynamic and echocardiographic response to therapy after 48 hours. Death, transplantation and rehospitalization were used as a combined endpoint. Sixty-nine ADHF patients, admitted for hemodynamically tailored therapy and with available baseline and follow-up echocardiogram, were dichotomized according to the MR jet direction (central vs. eccentric). Baseline demographic, hemodynamic and echocardiographic characteristics were compared in addition to hemodynamic and echocardiographic response to therapy after 48 hours. Death, transplantation and rehospitalization were used as a combined endpoint. Results ConclusionsDespite differences at baseline, MR mechanism, as adjudicated by jet direction, does not seem to influence hemodynamic or echocardiographic response during tailored therapy, nor prognosis. This suggests that improvement in leaflet coaptation and reduction in effective regurgitant orifice by intensive medical therapy occur to a same degree in either MR mechanisms. Despite differences at baseline, MR mechanism, as adjudicated by jet direction, does not seem to influence hemodynamic or echocardiographic response during tailored therapy, nor prognosis. This suggests that improvement in leaflet coaptation and reduction in effective regurgitant orifice by intensive medical therapy occur to a same degree in either MR mechanisms.