Clinical Course and Outcomes of Acute Heart Failure With Moderate-to-Severe Mitral or Tricuspid 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 postdischarge outcomes is less clear. This study analyzed 617 patients hospitalized for acute HF in the Diuretic Optimization Strategies in Acute Heart Failure (DOSE-AHF), Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF) trials. We assessed biomarkers, physical examination 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 with those without moderate-to-severe regurgitation (all p >0.05 at 72 hours). For patients with moderate-to-severe TR, there was more weight loss (-4.77 vs -2.83 pounds at 24 hours, p = 0.029; -9.32 vs -6.99 pounds at 72 hours, p = 0.007), net fluid loss (-4,988 vs -4,581 ml, p = 0.008), and improvement in creatinine (-0.09 mg/100 ml vs +0.06 mg/100 ml at 72 hours, p = 0.002) than those without moderate-to-severe regurgitation. In 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 or 96 hours). For postdischarge outcomes, compared with patients without moderate-to-severe regurgitation, moderate-to-severe MR was associated with a nonsignificant trend toward increased death, rehospitalization, or unscheduled clinic or emergency department visit 60 days after 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 toward worse postdischarge 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.