Prognostic Impact of Cardiorenal Anemia Syndrome in Patients With Atrial Functional Mitral Regurgitation: Subanalysis From REVEAL-AFMR Registry.

Background: Atrial functional mitral regurgitation (AFMR) frequently affects older patients, but the high-risk patient subgroups requiring careful follow-up and targeted therapy remain unclear. AFMR causes venous congestion and reduced forward cardiac output, which may accelerate chronic kidney disease (CKD) and anemia. Cardiorenal anemia syndrome (CRAS) is a known prognostic factor in heart failure (HF), and AFMR-specific hemodynamic disturbances may amplify its consequences. The aim of this study was to evaluate the impact of CRAS on cardiovascular outcomes in AFMR. Methods and Results: The multicenter, retrospective, observational REVEAL-AFMR registry enrolled patients with moderate-to-severe AFMR in 2019. Patients were stratified into CRAS and non-CRAS groups based on the simultaneous presence of HF, CKD, and anemia. The primary outcome was a composite of all-cause death and HF hospitalization. Among the 957 patients analyzed, 243 had CRAS. Over a median follow-up period of 1,043 days, 279 composite events occurred. Kaplan-Meier analysis demonstrated a higher incidence of composite outcomes in the CRAS group across all AFMR severities. Multivariable Cox regression analysis identified CRAS, older age, lower body mass index, and lower systolic blood pressure as independent predictors of cardiovascular events. Conclusions: CRAS is common in AFMR and may be independently associated with an increased risk of future cardiovascular events. Assessment of CRAS may be helpful for risk stratification and management in this population.