(P193) FACTORS ASSOCIATED WITH DEVELOPMENT OF SEVERE MR IN PATIENTS WITH HF

Background: Patients with heart failure (HF) and severe mitral regurgitation (MR) have poor outcomes. Early identification and treatment with maximally tolerated goal directed medical therapy and potentially device therapies, including transcatheter edge-to-edge repair, may improve outcomes and reduce mortality. We identified factors associated with progression to severe MR in patients with congestive heart failure (CHF).

We identified 7,391patients with a clinical diagnosis of HF and at least two echocardiograms at least 6 months apart, between April 1st, 2008 and March 31st, 2016. We excluded patients without severity of mitral regurgitation recorded at baseline (n=1840) or at follow-up (n=960). Additionally, we excluded patients with severe or moderate to severe MR at baseline (n=450). We evaluated associations with the development of severe MR using multivariable logistic regression analysis.

METHODS AND RESULTS: We identified 7,391patients with a clinical diagnosis of HF and at least two echocardiograms at least 6 months apart, between April 1st, 2008 and March 31st, 2016. We excluded patients without severity of mitral regurgitation recorded at baseline (n=1840) or at follow-up (n=960). Additionally, we excluded patients with severe or moderate to severe MR at baseline (n=450). We evaluated associations with the development of severe MR using multivariable logistic regression analysis.

A total of 7,391 patients were enrolled in the study (26% HFrEF, 16% HFmrEF, 56% HFpEF) out of which 4,173 (56.5%) were male, mean age of 75 (64-83). In total 357(4.8%) patients developed severe MR on repeat echocardiogram within a median of 1.4 years (IQR 0.9-2.4). In multivariable analyses, atrial fibrillation (adjusted odds ratio [aOR] 1.75, 95% confidence interval 1.39-2.21), left ventricular end-diastolic dimension (aOR 1.55 per 1cm, 95% CI 1.33-1.80) ischemic heart disease (aOR 1.39, 1.10-1.76), and hypertension (aOR 1.34, 1.01 - 1.80) were associated with progression to severe MR. Examination of medications revealed that only BB use was significantly associated with a lower risk of progression to severe MR (aOR 0.74, 95% CI 0.56 - 0.99).

Conclusion: We identified several factors independently associated with progression to severe MR in patients with HF, most notably were atrial fibrillation, ischemic heart disease and left ventricular end-diastolic dimension. This information could potentially be used by clinicians to identify patients who require closer echocardiographic follow-up to ensure early initiation of optimal medical and device interventions for prevention of MR progression.