Objectives To define prevalence, long term outcome, and treatment standards of secondary mitral regurgitation (sMR) across the heart failure spectrum. Design Large scale cohort study. Setting Observational cohort study with data from the Viennese community healthcare provider network between 2010 and 2020, Austria. Participants 13 223 patients with sMR across all heart failure subtypes. Main outcome measures Association between sMR and mortality in patients assigned by guideline diagnostic criteria to one of three heart failure subtypes: reduced, mid-range, and preserved ejection fraction, was assessed. Results Severe sMR was diagnosed in 1317 patients (10%), correlated with increasing age (P<0.001), occurred across the entire spectrum of heart failure, and was most common in 656 (25%) of 2619 patients with reduced ejection fraction. Mortality of patients with severe sMR was higher than expected for people of the same age and sex in the same community (hazard ratio 7.53; 95% confidence interval 6.83 to 8.30, P<0.001). In comparison with patients with heart failure and no/mild sMR, mortality increased stepwise with a hazard ratio of 1.29 (95% confidence interval 1.20 to 1.38, P<0.001) for moderate and 1.82 (1.64 to 2.02, P<0.001) for severe sMR. The association between severe sMR and excess mortality was consistent after multivariate adjustment and across all heart failure subgroups (mid-range ejection fraction: hazard ratio 2.53 (95% confidence interval 2.00 to 3.19, P<0.001), reduced ejection fraction: 1.70 (1.43 to 2.03, P<0.001), and preserved ejection fraction: 1.52 (1.25 to 1.85, P<0.001)). Despite available state-of-the-art healthcare, high volume heart failure, and valve disease programmes, severe sMR was rarely treated by surgical valve repair (7%) or replacement (5%); low risk transcatheter repair (4%) was similarly seldom used. Conclusion Secondary mitral regurgitation is common overall, increasing with age and associated with excess mortality. The association with adverse outcome is significant across the entire heart failure spectrum but most pronounced in those with mid-range and reduced ejection fractions. Despite these poor outcomes, surgical valve repair or replacement are rarely performed; similarly, low risk transcatheter repair, specifically in the heart failure subsets with the highest expected benefit from treatment, is seldom used. The current data suggest an increasing demand for treatment, particularly in view of an expected increase in heart failure in an ageing population. Data sharing: No additional data available.

中文翻译：

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整个心力衰竭谱中继发性二尖瓣关闭不全的负担、治疗使用和结果：观察性队列研究

目的 定义整个心力衰竭谱中继发性二尖瓣关闭不全 (sMR) 的患病率、长期结果和治疗标准。设计大规模队列研究。使用 2010 年至 2020 年间奥地利维也纳社区医疗保健提供者网络的数据设置观察性队列研究。参与者 13 223 名 sMR 患者，包括所有心力衰竭亚型。主要结果测量 sMR 与根据指南诊断标准指定为三种心力衰竭亚型之一的患者死亡率之间的关联：射血分数降低、中等和射血分数保留。结果 1317 名患者 (10%) 诊断出严重 sMR，与年龄增长相关 (P<0.001)，发生在整个心力衰竭谱中，并且在 2619 名射血分数降低的患者中最常见的有 656 名 (25%)。重度sMR患者的死亡率高于同一社区同年龄和性别的人的预期（风险比7.53；95%置信区间6.83至8.30，P<0.001）。与心力衰竭和无/轻度 sMR 患者相比，死亡率逐步增加，中度风险比为 1.29（95% 置信区间 1.20 至 1.38，P<0.001），重度风险比为 1.82（1.64 至 2.02，P<0.001）先生。多变量调整后严重 sMR 与高死亡率之间的关联在所有心力衰竭亚组中是一致的（中等射血分数：风险比 2.53（95% 置信区间 2.00 至 3.19，P<0.001），射血分数降低：1.70（1.43至 2.03，P<0.001），射血分数保留：1.52（1.25 至 1.85，P<0.001））。尽管有最先进的医疗保健，高容量心力衰竭和瓣膜疾病计划，严重 sMR 很少通过手术瓣膜修复 (7%) 或置换术 (5%) 进行治疗；低风险经导管修复 (4%) 同样很少使用。结论继发性二尖瓣关闭不全总体上很常见，随着年龄的增长而增加，并与死亡率过高有关。与不良结果的相关性在整个心力衰竭谱中都很显着，但在射血分数中等和降低的患者中最为明显。尽管结果不佳，但很少进行外科瓣膜修复或置换。同样，低风险经导管修复术，特别是在治疗预期收益最高的心力衰竭亚组中，也很少使用。目前的数据表明对治疗的需求不断增加，特别是考虑到老龄人口中心力衰竭的预期增加。数据共享：没有可用的额外数据。