Abstract 4143003: Association of Mitral Regurgitation with Heart Failure Subtypes in Patients with Chronic Kidney Disease: the CRIC Study

Background: Data on the association between mitral regurgitation (MR) and heart failure (HF) subtypes in participants with chronic kidney disease (CKD) are scarce. Hypothesis: We hypothesized that the worsening of MR severity is associated with the incidence of both HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction in participants with CKD. Additionally, these associations may differ by sex, race, or the presence of atrial fibrillation (AF). Methods: We studied participants with CKD who had an echocardiography exam (2013-2015) in the Chronic Renal Insufficiency Cohort (CRIC) study and were free of HF at the time of enrollment in the study. The incidence of HFpEF and HFrEF was determined and classified based on the hospitalization diagnosis and ejection fraction measured by echocardiography during the hospitalization or follow-up visits. The level of MR severity was categorized as absent/trace, mild, and moderate/severe based on visualization and quantification of the effective regurgitant orifice area from an apical-four chamber. Multivariable Cox hazard models were used to examine the association of MR degree with the incidence of overall HF, HFpEF, and HFrEF. Results: Among 2951 participants with CKD (58.9 years, 46.1% women, and 73.4% with MR), 309 incident HFpEF and 322 incident HFrEF were confirmed during follow-up. Worsening MR severity was associated with the incidence of HFpEF (hazard ratio [HR] 1.65, p =0.04) and HFrEF (hazard ratio 1.91, p <0.001), independent of traditional clinical risk factors, ejection fraction, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio ( Table 1 ). In addition, AF accounted for 10.1% and 11.1% of the association of MR severity with HFpEF and HFrEF, respectively. Furthermore, MR severity was associated with HFrEF in women (HR 4.04, p <0.001, p sex- interaction =0.0019), but not in men (HR 1.20, p =0.80). Conclusion: In patients with CKD, worsening MR severity was significantly and independently associated with the risk of HFpEF and HFrEF. These associations are partially explained by the presence of AF.