Prognostic significance of atrial functional mitral regurgitation in patients with HFpEF and end-stage renal disease.

Abstract

Atrial functional mitral regurgitation (AFMR) is common in patients with heart failure with preserved ejection fraction (HFpEF) and end-stage renal disease (ESRD) undergoing hemodialysis, but its prognostic value and potential diagnostic biomarkers remain unclear. We conducted a retrospective cohort study involving 452 patients with HFpEF and ESRD undergoing maintenance hemodialysis between August 2018 and September 2023. Clinical outcomes were analyzed using Kaplan-Meier curves and Cox regression. Additionally, 101 patients were prospectively recruited to explore the diagnostic value of plasma atrial natriuretic peptide (ANP) levels for AFMR using ROC analysis. AFMR was associated with significantly higher all-cause mortality (25.6% vs. 12.3%, P = 0.0070). Multivariate Cox regression confirmed AFMR as an independent predictor of all-cause mortality (HR: 2.456; P = 0.0090). Even mild AFMR was associated with a higher risk of all-cause mortality (HR: 2.155; P = 0.0150). Moderate-severe AFMR was significantly related to a higher incidence of cardiac function deterioration, not only compared with the non-AFMR group (HR: 4.041; 95% CI: 1.186-13.763; P = 0.026), but also compared with the mild AFMR group (HR: 3.622; 95% CI: 1.187-11.050; P = 0.024). Moreover, ANP levels were significantly elevated in the AFMR group compared to non-AFMR, which could be a significant predictor of AFMR (AUC = 0.73). AFMR is associated with higher all-cause mortality and worsening cardiac function in patients with HFpEF and ESRD undergoing hemodialysis. ANP may serve as a potential biomarker for diagnosis of AFMR in this patient population. These results underscore the importance of early detection and management of AFMR in this high-risk population.