International journal of cardiology. Heart & vasculature · 2026
Prevalence and prognostic implications of chronic kidney disease in patients with atrial functional mitral regurgitation.
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Morita Yusuke, Sakamoto Takahiro, Okada Taiji, Kaneko Tomohiro, Amano Masashi, Sato Yukio, Ohno Yohei, Obokata Masaru, Sato Kimi, Machino-Ohtsuka Tomoko, Abe Yukio, Tanabe Kazuaki, Kagiyama Nobuyuki, REVEAL-AFMR study group
Аннотация
BACKGROUND: Atrial functional mitral regurgitation (AFMR) is increasingly recognized as a distinct mitral regurgitation subtype; the prognostic impact of coexisting chronic kidney disease (CKD) remains unclear.
METHODS: Data from 989 patients enrolled in the multicenter REVEAL-AFMR registry were analyzed. Coexisting CKD was defined as reduced estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Patients were further classified by CKD severity as stage 1 + 2 (eGFR ≥60), stage 3a (eGFR ≥45 and < 60), stage 3b (eGFR ≥30 and < 45), and stage 4 + 5 (eGFR <30). The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. Kaplan-Meier and multivariable Cox regression analyses were performed to assess the primary endpoint.
RESULTS: Coexisting CKD was present in 429 of 989 patients (43.4%). Lower eGFR was associated with more advanced mitral regurgitation (MR), higher BNP levels, and more severe heart failure symptoms. Over a median follow-up of 1002 days, 181 patients (18.3%) experienced the primary endpoint. The cumulative incidence of the primary endpoint increased stepwise across CKD stages (log-rank P < 0.001). In multivariable analysis, CKD stage remained independently associated with adverse outcomes (HR 1.26; 95% CI 1.09-1.46; P = 0.002). This association was consistent across MR severity strata, with no significant interaction between MR severity and CKD stage.
CONCLUSION: Among conservatively managed patients with AFMR, CKD is common in AFMR, and CKD stage is independently associated with worse outcomes in a graded manner, irrespective of MR severity. Renal function assessment may improve AFMR risk stratification.
METHODS: Data from 989 patients enrolled in the multicenter REVEAL-AFMR registry were analyzed. Coexisting CKD was defined as reduced estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Patients were further classified by CKD severity as stage 1 + 2 (eGFR ≥60), stage 3a (eGFR ≥45 and < 60), stage 3b (eGFR ≥30 and < 45), and stage 4 + 5 (eGFR <30). The primary endpoint was a composite of cardiovascular death and heart failure hospitalization. Kaplan-Meier and multivariable Cox regression analyses were performed to assess the primary endpoint.
RESULTS: Coexisting CKD was present in 429 of 989 patients (43.4%). Lower eGFR was associated with more advanced mitral regurgitation (MR), higher BNP levels, and more severe heart failure symptoms. Over a median follow-up of 1002 days, 181 patients (18.3%) experienced the primary endpoint. The cumulative incidence of the primary endpoint increased stepwise across CKD stages (log-rank P < 0.001). In multivariable analysis, CKD stage remained independently associated with adverse outcomes (HR 1.26; 95% CI 1.09-1.46; P = 0.002). This association was consistent across MR severity strata, with no significant interaction between MR severity and CKD stage.
CONCLUSION: Among conservatively managed patients with AFMR, CKD is common in AFMR, and CKD stage is independently associated with worse outcomes in a graded manner, irrespective of MR severity. Renal function assessment may improve AFMR risk stratification.