# Residuele matige secundaire mitralisinsufficiëntie na GDMT verhoogt sterfte en heropname bij hartfalen

*geplaatst 2026-10-24 · Hartfalen · ESC heart failure · doi 10.1093/eschf/xvag256 · https://hartvaat.nl/2026/10/17/residuele-matige-secundaire-mitralisinsufficientie-na-gdmt-verhoogt-sterfte-en-h/*

In een cohort van 2.468 ambulante hartfalenpatiënten bleek residuele matige secundaire mitralisinsufficiëntie (MR) na 12 maanden geoptimaliseerde medicamenteuze therapie (GDMT) bij 15,6% van de patiënten voor te komen. Gedurende een mediane follow-up van 6,9 jaar was deze matige MR onafhankelijk geassocieerd met een verhoogd risico op de primaire endpoint (sterfte of eerste HF-heropname; HR 1,69) en een verdubbeling van het heropnameratio (IRR 2,17) vergeleken met geen of lichte MR. Deze bevindingen onderstrepen dat matige MR na GDMT-optimalisatie een belangrijke risicomarker is die klinisch gebruikt kan worden voor stratificatie en timing van interventieve opties zoals TEER.

## English: Prognostic Impact of Moderate Secondary Mitral Regurgitation After Optimized Medical Therapy in Heart Failure.

A cohort of 2,468 ambulatory heart failure patients was evaluated to assess the prognostic impact of residual moderate secondary mitral regurgitation (MR) after 12 months of optimized guideline-directed medical therapy (GDMT). During a median 6.9-year follow-up, moderate MR (present in 15.6% of patients) was independently associated with a higher risk of the composite endpoint of death or first HF hospitalization (HR 1.69) and a more than twofold increase in recurrent HF hospitalizations (IRR 2.17) compared to no or mild MR. These findings highlight that persistent moderate MR after GDMT optimization serves as a robust prognostic marker, aiding risk stratification and informing the timing of advanced therapies such as transcatheter edge-to-edge repair.

## Abstract (original, from the publication)

BACKGROUND: The prognostic significance of moderate secondary mitral regurgitation (MR) after optimized guideline-directed medical therapy (GDMT) in heart failure (HF) remains uncertain. METHODS: We analyzed 2,468 ambulatory HF patients with paired transthoracic echocardiography at baseline and after 12 months of optimized GDMT. The primary composite was all-cause death or first heart failure hospitalization (HFH). Secondary endpoints included all-cause mortality and recurrent HFHs. RESULTS: Mean age was 66.2 ± 12.5 years, 70.6% were male, and mean baseline LVEF was 36.1% ± 13.6%. At 12 months, 80.5% of patients had no/mild MR, 15.6% had moderate MR, and 3.9% had severe MR. During a median 6.9-year follow-up, 1,240 patients experienced the primary endpoint. Compared with no/mild MR, both moderate and severe MR at 12 months were independently associated with a higher risk of the primary composite endpoint (moderate: hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.47-1.95; severe: HR 1.81, 95% CI 1.44-2.29; both p<0.001). Moderate MR was also independently associated with increased all-cause mortality (HR 1.54, 95% CI 1.32-1.79; p<0.001) and recurrent HFHs (incidence rate ratio [IRR] 2.17, 95% CI 1.81-2.60). HFH rates were 9.03, 20.0, and 26.1 per 100 person-years in patients with no/mild, moderate, and severe MR, respectively. Among patients with moderate MR at 12 months, outcomes did not differ according to baseline MR severity. CONCLUSIONS: In this large-scale study, residual moderate secondary MR after 12 months of optimized GDMT was common and was independently associated with increased long-term mortality and HFHs.

Auteurs: Cristina Ferrero, Pau Codina, Josep Lupón, María Ruiz-Cueto, Elisabet Zamora, Andrea Borrellas, Cinta Llibre, Clara Badia-Molins, Andrea Carrete, Evelyn Santiago-Vacas, Mar Domingo, Javier Santesmases, Elena Ferrer-Sistach, Claudia Escabia, Julio Núñez, Stefan D Anker, Marco Metra, Javed Butler, Gregg W Stone, Victoria Delgado, Antoni Bayes-Genis

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Bron: ESC heart failure, https://doi.org/10.1093/eschf/xvag256. Bijgewerkt 2026-10-18T00:54:59Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.