Mitral regurgitation in patients with heart failure and reduced ejection fraction: insights from GALACTIC-HF.
Misato Chimura, Kieran F Docherty, Pardeep S Jhund et al.
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In 30 seconds
This analysis of the randomized, multicentre GALACTIC-HF trial examined mitral regurgitation (MR) and outcomes in patients with heart failure and reduced ejection fraction. Among 7998 patients with baseline MR data, 15.3% had moderate MR and only 25 had severe MR. Moderate MR was associated with a higher risk of the composite of a first heart-failure event or cardiovascular death than no MR (adjusted HR 1.11; 95% CI 1.01-1.23); mild MR was not. MR was not associated with mortality in adjusted analyses, and it did not modify the treatment effect of omecamtiv mecarbil.
Key findings
- Moderate MR was present in 15.3% of patients with baseline MR data; only 25 patients had severe MR.
- Moderate MR was associated with higher risk of the primary outcome than no MR (adjusted HR 1.11; 95% CI 1.01-1.23); mild MR was not.
- The association between moderate MR and the primary outcome was most prominent in patients with less severe heart failure.
- MR did not modify the beneficial treatment effect of omecamtiv mecarbil versus placebo on clinical outcomes.
Why it matters
The findings indicate that moderate secondary MR identifies a group with higher risk of heart-failure events or cardiovascular death, although the association was modest and was not seen for mortality in adjusted analyses. The relationship was most apparent in patients with less severe heart failure, underscoring that MR and overall heart-failure severity should be considered together when interpreting risk.
What to keep in mind
Only 25 patients had severe MR, limiting conclusions about that subgroup. The reported MR-outcome relationship is an adjusted association, not evidence that MR causes the higher risk.