Impact of contemporary guideline-directed medical therapy on secondary mitral and tricuspid regurgitation in heart failure with reduced ejection fraction

BACKGROUND AND AIMS: We aimed to assess regression and development rates of ≥moderate secondary MR and TR in patients with HFrEF in association with contemporary GDMT. METHODS: Patients with <1 year diagnosis of HFrEF with mildly (40%≤EF<50%) or moderately (<40%) reduced EF enrolled in GDMT titration program 2019-2024 were identified. Rates of regression of ≥moderate MR/TR to ≤mild and rates of development of incident ≥moderate MR/TR were calculated. RESULTS: Among 844 patients (median age 64; 68% men; 26% mildly reduced EF; 24% NYHA class III/IV), 28% had ≥moderate MR and 14% had ≥moderate TR at baseline. Over median 7.1 months, 171 (75%) patients with ≥moderate MR experienced regression to no/mild MR. Similarly, 87 (75%) patients with ≥moderate TR had regression to no/mild TR over the same period. In contrast, over median 13 months, incident ≥moderate MR developed in 5% of patients with no/mild baseline MR and incident ≥moderate TR developed in 6% with no/mild baseline TR. Number of GDMT medications at follow-up was less in patients who did not have MR/TR regression (vs who did) and in patients who developed MR/TR (vs who did not). On subgroup analysis, patients with NYHA class I/II received similar number of GDMT and had similar rate of MR and TR regression and development vs patients with NYHA III/IV. However, patients with mildly reduced EF received less GDMT medications vs patients with moderately reduced EF and experienced less MR regression. CONCLUSION: In patients with a recent diagnosis of HFrEF receiving contemporary GDMT, the majority of patients with ≥moderate secondary MR and TR achieved regression of MR/TR, and the minority of patients without significant baseline MR/TR developed ≥moderate regurgitation at follow-up.