Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR.

Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint.

Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887–0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006–1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945–0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614–0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056–7.067, p = 0.038) were also independent predictors of the HF-related endpoints.

Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.

背景：急性失代偿性心力衰竭 (ADHF) 住院患者经常表现出加重的二尖瓣关闭不全 (MR)。这些患者并不总是接受外科二尖瓣修复术，但特别是在老年人中，他们经常接受保守药物治疗。本研究旨在调查影响未经手术治疗的 MR 住院心力衰竭 (HF) 患者 6 个月预后的因素。

方法：我们在 2017 年 9 月至 2020 年 5 月期间在山口县立大医疗 (YPGM) 中心筛查了住院 HF 患者中 MR 的存在。在这些患者出院时，未经手术的 MR 患者，包括原发性和继发性 MR，因此被招募到这项单中心前瞻性队列研究中。本研究不包括接受二尖瓣手术治疗的重度 MR 患者。主要终点是全因再入院或全因死亡，次要终点是出院后 6 个月的 HF 相关终点。Cox 比例风险回归分析用于评估复合终点的预测因子。

结果：总体而言，YPGM 中心收治了 489 名 ADHF 患者。其中，146 名患者（占 HF 患者总数的 30%）（中位年龄 83.5 岁，69 名男性）被确定为患有 II 级或更高级别的 MR。因此，所有招募的患者都被诊断为功能性MR。在 186.0 天的中位随访期间，共有 55 名患者（38%）达到主要或次要终点（31 名患者 HF 死亡和再入院，24 名患者其他）。作为多变量分析的结果，老年营养风险指数 [风险比 (HR) = 0.932；95% CI = 0.887–0.979，p= 0.005]，年龄（HR = 1.058；95% CI = 1.006–1.112，p= 0.027）和左心室射血分数（HR = 0.971；95% CI = 0.945–0.997，p= 0.030）是全因死亡或全因入院的独立预测因子。体重指数（HR = 0.793；95% CI = 0.614–0.890，p= 0.001) 和缺血性心脏病病因学 (HR = 2.732; 95% CI = 1.056–7.067,p= 0.038）也是 HF 相关终点的独立预测因子。

结论：营养不良和体重不足是患有未经手术治疗的中度至重度功能性 MR 的老年 HF 患者不良结局的重要预测因素。