Objectives: To assess the prevalence and impact of mitral regurgitation (MR) on survival in patients presenting to hospital in acute heart failure (AHF) using traditional echocardiographic assessment alongside more novel indices of proportionality.

Background: It remains unclear if the severity of MR plays a significant role in determining outcomes in AHF. There is also uncertainty as to the clinical relevance of indexing MR to left ventricular volumes. This concept of disproportionality has not been assessed in AHF.

Methods: A total of 418 consecutive patients presenting in AHF over 12 months were recruited and followed up for 2 years. MR was quantitatively assessed within 24 h of recruitment. Standard proximal isovelocity surface area (PISA) and a novel proportionality index of effective regurgitant orifice/left ventricular end-diastolic volume (ERO/LVEDV) >0.14 mm²/ml were used to identify severe and disproportionate MR.

Results: Every patient had MR. About 331/418 (78.9%) patients were quantifiable by PISA. About 165/418 (39.5%) patients displayed significant MR. A larger cohort displayed disproportionate MR defined by either a proportionality index using ERO/LVEDV > 0.14 mm²/ml or regurgitant volumes/LVEDV > 0.2 [217/331 (65.6%) and 222/345 (64.3%), respectively]. The LVEDV was enlarged in significant MR−129.5 ± 58.95 vs. 100.0 ± 49.91 ml in mild, [p < 0.0001], but remained within the normal range. Significant MR was associated with a greater mortality at 2 years {44.2 vs. 34.8% in mild MR [hazard ratio (HR) 1.39; 95% CI: 1.01–1.92, p = 0.04]}, which persisted with adjustment for comorbid conditions (HR; 1.43; 95% CI: 1.04–1.97, p = 0.03). Disproportionate MR defined by ERO/LVEDV >0.14 mm²/ml was also associated with worse outcome [42.4 vs. 28.3% (HR 1.62; 95% CI 1.12–2.34, p = 0.01)].

Conclusions: MR was a universal feature in AHF and determines outcome in significant cases. Furthermore, disproportionate MR, defined either by effective regurgitant orifice (ERO) or volumetrically, is associated with a worse prognosis despite the absence of adverse left ventricular (LV) remodeling. These findings outline the importance of adjusting acute volume overload to LV volumes and call for a review of the current standards of MR assessment.

Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT02728739, identifier NCT02728739.

目标： 使用传统的超声心动图评估以及更新颖的比例指数，评估二尖瓣关闭不全 (MR) 对因急性心力衰竭 (AHF) 住院的患者的生存率和生存率的影响。

背景：目前尚不清楚 MR 的严重程度是否在决定 AHF 的结果方面起重要作用。对于将 MR 与左心室容积进行索引的临床相关性也存在不确定性。这种不成比例的概念尚未在 AHF 中进行评估。

方法：总共招募了 418 名连续 12 个月出现 AHF 的患者，并随访了 2 年。在招募后 24 小时内对 MR 进行定量评估。标准近端等速表面积 (PISA) 和有效反流口/左心室舒张末期容积 (ERO/LVEDV) > 0.14 mm ² /ml的新型比例指数用于识别严重和不成比例的 MR。

结果：每个病人都有 MR。大约 331/418 (78.9%) 的患者可以通过 PISA 进行量化。大约 165/418 (39.5%) 患者表现出显着的 MR。更大的队列显示不成比例的 MR，由使用 ERO/LVEDV > 0.14 mm ² /ml 或返流量/LVEDV > 0.2 [分别为 217/331 (65.6%) 和 222/345 (64.3%)]的比例指数定义。LVEDV 显着增大，MR-129.5 ± 58.95 与轻度 100.0 ± 49.91 ml，[p< 0.0001]，但仍处于正常范围内。显着的 MR 与更高的 2 年死亡率相关{44.2 vs. 34.8% 轻度 MR [风险比 (HR) 1.39；95% 置信区间：1.01–1.92，p = 0.04]}，随着合并症的调整而持续存在（HR；1.43；95% CI：1.04–1.97， p= 0.03）。由 ERO/LVEDV >0.14 mm ² /ml定义的不成比例的 MR也与较差的结果相关 [42.4 vs. 28.3% (HR 1.62; 95% CI 1.12–2.34,p = 0.01)]。

结论：MR 是 AHF 的一个普遍特征，并决定了重要病例的结果。此外，由有效反流口 (ERO) 或容积定义的不成比例的 MR 与较差的预后相关，尽管没有不利的左心室 (LV) 重构。这些发现概述了将急性容量超负荷调整为 LV 容量的重要性，并呼吁审查当前的 MR 评估标准。

临床试验注册：https://clinicaltrials.gov/ct2/show/NCT02728739, 标识符 NCT02728739。