Clinical profile and outcomes of patients with heart failure according to mitral regurgitation severity
S Humanes Ybanez, A Fraile Sanz, M De La Serna, M Gutierrez Munoz, P Rodriguez, P Gil Mancebo, E Parrales, A Vilchez, M Martin Munoz, C Utrilla, I Miralles, R Mata Caballero, J Perea Ejido, J L Santiago Ruiz, J J Alonso MartinAbstract
Background
Mitral regurgitation is a frequent finding in patients with heart failure and reflects advanced ventricular remodelling and loading conditions. The clinical relevance of more than moderate mitral regurgitation in unselected heart failure populations warrants specific characterization.
Purpose
To assess clinical characteristics, echocardiographic profile, and outcomes of patients with heart failure according to the presence of more than moderate mitral regurgitation
Methods
We performed a retrospective analysis of consecutive patients admitted with heart failure from 2020 to 2025. Patients were stratified based on echocardiographic severity of mitral regurgitation (> moderate vs. ≤ moderate). Demographic data, clinical presentation, echocardiographic parameters, biomarkers, and outcomes were analysed. Median follow-up was 11 months (IQR 10–12).
Results
Among 445 patients included, 29 (6.5%) presented with more than moderate MR. Compared with patients with ≤ moderate MR, those with more severe MR more frequently presented with left-sided HF (93% vs. 77%, p=0.04), whereas right-sided HF was less prevalent (21% vs. 45%, p=0.011). Dilated cardiomyopathy was significantly more common in the MR > moderate group (48% vs. 25%, p=0.006). Echocardiographic assessment revealed a more advanced phenotype, with greater left ventricular dilation, reduced left ventricular ejection fraction (30% vs. 44%, p<0.001), larger ventricular diameters, and higher E/A ratio (1.9 vs. 1.0, p=0.027). Diastolic dysfunction was reflected by elevated E/e’ values in patients with more than moderate MR (median 18 vs. 15), although differences were not statistically significant (p=0.56). Biventricular involvement was more frequent, with higher prevalence of right ventricular dysfunction (46% vs. 27%, p=0.02) and pulmonary hypertension (78% vs. 50%, p=0.005). Natriuretic peptide levels at admission were significantly higher in the MR > moderate group. During follow-up, time to HF readmission was numerically shorter in patients with more than moderate MR (5 vs. 7 months, p=0.54). Cardiovascular mortality was numerically higher but did not differ significantly between groups (19% vs. 12%, p=0.3).
Conclusion
in an unselected HF population, more than moderate MR identifies a small but distinct subgroup with advanced ventricular remodelling, diastolic dysfunction, and biventricular involvement. Although short-term outcomes were similar, MR severity provides meaningful clinical and echocardiographic information that may aid risk stratification in patients with HF.For image description, please refer to the figure legend and surrounding text.