Prognostic impact of precipitated cardiac decompensation in symptomatic heart failure with reduced ejection fraction and severe secondary mitral regurgitation - 11/10/23
, Erwan Donal, MD, PhD b, François Picard, MD c, François Derimay, MD, PhD a, Daniel Grinberg, MD, PhD d, Delphine Maucort Boulch, MD, PhD e, Thomas Bochaton, MD, PhD a, Nicolas Piriou, MD f, Amélie De Lorgeril, MD a, Geraldine Samson, Pharm D a, Frédéric Rouleau, MD, PhD g, Benjamin Riche, PhD e, Jean Noël Trochu, MD, PhD fRésumé |
Background |
Our aim was to assess the distribution of primary (with no trigger) and secondary (with a decompensation trigger) heart failure events in a severe heart failure population and their association with 2-year all-cause mortality in the Mitra.Fr study.
Methods |
We included 304 patients with symptomatic heart failure, and severe mitral regurgitation and guideline directed medical therapy randomized to medical therapy alone or medical therapy with percutaneous mitral valve repair. According to the follow-up, we defined 3 categories of events: follow-up without any heart failure event, at least 1 decompensation starting with a primary heart failure decompensation or starting with a precipitated secondary heart failure event. The primary outcome was 2-years all-cause mortality.
Results |
A total of 179 patients (59 %) had at least 1 heart failure decompensation within 24-months of follow-up. 129 heart failure decompensations (72%) were a first primary heart failure and 50 (28%) were a first secondary decompensation. Finally, 30 patients had both types of decompensations but these were not taken into account for the comparison of primary and secondary decompensations. Primary decompensations were 3-times more frequent than secondary decompensations, but the mean number of heart failure decompensations was similar in the “Primary heart failure group” compared to the “Secondary heart failure group”: (1.94 ± 1.39 vs 1.80 ± 1.07 respectively; P = .480). Compared to patients without heart failure decompensation, patients with “Only primary decompensation” or with “Only secondary decompensation” had a significantly increased risk of death (HR = 4.87, 95% CI [2.86, 8.32] and 2.68 95%CI [1.64, 4.37] respectively). All-cause mortality, was not significantly different between these 2 type of decompensations (HR = 1.82, 95% CI [0.93, 3.58]; P = .082), but each additional heart failure recurrence was associated with a significant increase in mortality risk (HR = 1.27, 95% CI [1.08; 1.50]; P = .005).
Conclusions |
In heart failure with reduced ejection fraction and severe secondary mitral regurgitation patients, primary heart failure decompensations were 3-times more frequent compared to precipitated decompensations with a nonsignificant trend in increased risk of all-cause mortality. Our results fail to support the differentiation between primary and secondary decompensations as they seem to portend the same outcome impact.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Plan
Vol 265
P. 83-91 - novembre 2023 Retour au numéro
Article précédent
- Cardiovascular hospitalizations for Medicare advantage beneficiaries in the United States, 2009 to 2019
- Andrew S. Oseran, Huaying Dong, Rishi K. Wadhera
- Accuracy and variability of cardiologist interpretation of single lead electrocardiograms for atrial fibrillation: The VITAL-AF trial
- Daniel C. Pipilas, Shaan Khurshid, Steven J. Atlas, Jeffrey M. Ashburner, Ana T. Lipsanopoulos, Leila H. Borowsky, Wyliena Guan, Patrick T. Ellinor, David D. McManus, Daniel E. Singer, Yuchiao Chang, Steven A. Lubitz
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?