{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:37:04Z","timestamp":1792841824881,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":51,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The prognostic significance of moderate secondary mitral regurgitation (MR) after optimized guideline-directed medical therapy (GDMT) in heart failure (HF) remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 2468 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of patients was 66.2 \u00b1 12.5 years, 70.6% were male, and the mean baseline left ventricular ejection fraction was 36.1% \u00b1 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, 1240 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\u20131.95; severe: HR 1.81, 95% CI 1.44\u20132.29; both P &amp;lt; .001). Moderate MR was also independently associated with increased all-cause mortality (HR 1.54, 95% CI 1.32\u20131.79; P &amp;lt; .001) and recurrent HFHs (incidence rate ratio 2.17, 95% CI 1.81\u20132.60). Heart failure hospitalization 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag256","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:34:06Z","timestamp":1791286446000},"source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of moderate secondary mitral regurgitation after optimized medical therapy in heart failure"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8941-2631","authenticated-orcid":false,"given":"Cristina","family":"Ferrero","sequence":"first","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pau","family":"Codina","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Lup\u00f3n","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]},{"name":"Department of Cardiology, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia , Avenida Blasco Ib\u00e1\u00f1ez 17, Valencia 46010 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Ruiz-Cueto","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Zamora","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]},{"name":"Department of Cardiology, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia , Avenida Blasco Ib\u00e1\u00f1ez 17, Valencia 46010 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Borrellas","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinta","family":"Llibre","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Badia-Molins","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Carrete","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Santiago-Vacas","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Cardiology, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia , Avenida Blasco Ib\u00e1\u00f1ez 17, Valencia 46010 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"Domingo","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Santesmases","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1795-2193","authenticated-orcid":false,"given":"Elena","family":"Ferrer-Sistach","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Escabia","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1672-7119","authenticated-orcid":false,"given":"Julio","family":"N\u00fa\u00f1ez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia , Avenida Blasco Ib\u00e1\u00f1ez 17, Valencia 46010 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK) of German Heart Center Charit\u00e9, German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charit\u00e9 Universit\u00e4tsmedizin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7683-4720","authenticated-orcid":false,"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg W","family":"Stone","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai Division of cardiology, Department of Medicine, , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-2737","authenticated-orcid":false,"given":"Victoria","family":"Delgado","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3044-197X","authenticated-orcid":false,"given":"Antoni","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, CIBERCV , Carretera del Canyet s\/n, Badalona 08916 ,","place":["Spain"]},{"name":"Department of Medicine, Universitat Aut\u00f2noma de Barcelona , Passeig de la Vall d\u2032Hebron 119-129, Barcelona 08035 ,","place":["Spain"]},{"name":"Department of Cardiology, Hospital Cl\u00ednico Universitario de Valencia, Universitat de Valencia , Avenida Blasco Ib\u00e1\u00f1ez 17, Valencia 46010 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"2026102406470898900_xvag256-B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.shj.2022.100129","article-title":"Structural heart secondary mitral regurgitation: cardiac remodeling, diagnosis, and management","volume":"7","author":"Huang","year":"2023","journal-title":"Struct Heart"},{"key":"2026102406470898900_xvag256-B2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1093\/eurheartj\/ehx402","article-title":"Refining the prognostic impact of functional mitral regurgitation in chronic heart failure","volume":"39","author":"Goliasch","year":"2018","journal-title":"Eur Heart J"},{"key":"2026102406470898900_xvag256-B3","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1093\/eurheartj\/ehab086","article-title":"The management of secondary mitral regurgitation in patients with heart failure: a joint position 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