Impact of contemporary guideline-directed medical therapy on secondary mitral and tricuspid regurgitation in heart failure with reduced ejection fraction

Summary

This observational cohort study of 844 patients with recently diagnosed heart failure and reduced ejection fraction found that 75% of those with baseline moderate-or-greater secondary mitral or tricuspid regurgitation experienced regression to mild-or-less severity over a median 7.1 months whilst receiving contemporary guideline-directed medical therapy, whilst new moderate-or-greater regurgitation developed in only 5–6% of patients with baseline none-or-mild regurgitation over 13 months. Patients who did not achieve regurgitation regression or who developed new regurgitation received fewer GDMT medications, and those with mildly reduced ejection fraction received less intensive therapy and experienced less regurgitation improvement than those with moderately reduced ejection fraction.

Regional applicability

Although the study was conducted in the United States, the contemporary GDMT protocols and clinical outcomes reported are broadly aligned with European and United Kingdom heart failure management guidelines. Transferability to UK practice is reasonable, though UK cohort characteristics and medication titration patterns may differ slightly; direct application would benefit from confirmation in a UK-based cohort.

Key measures

Regression rates of ≥moderate mitral regurgitation (MR) and tricuspid regurgitation (TR) to ≤mild; development rates of incident ≥moderate MR/TR; number of GDMT medications at follow-up; ejection fraction categories (40–50% vs <40%); New York Heart Association functional class

Outcomes reported

The study measured regression rates of moderate-or-greater secondary mitral and tricuspid regurgitation to mild-or-less severity, and incidence rates of new moderate-or-greater regurgitation in patients with recently diagnosed heart failure with reduced ejection fraction receiving contemporary guideline-directed medical therapy. Association between the number of GDMT medications titrated and regurgitation outcomes was also assessed.

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