背景：本研究旨在評估二尖瓣逆流（mitral regurgitation, MR）嚴重程度與慢性血液透析（hemodialysis, HD）患者之臨床與心臟狀況的相關性，以及其與心血管預後及整體死亡率之關聯。方法：本研究共納入2018年10月至12月期間接受心臟超音波檢查的238名成年慢性HD患者，並追蹤至2021年底、轉院或死亡。依據MR嚴重程度，將患者分為無MR、輕度MR及中重度MR三組。進一步分析MR嚴重程度與重大不良心血管事件（major adverse cardiovascular events, MACEs）、心血管死亡率及整體死亡率之關聯，並進行亞組分析以辨識其他危險因子。結果：238名HD患者中，48人無MR、157人輕度MR、33人中重度MR。中重度MR顯著與左心室肥厚、下腔靜脈徑擴大及左心室射出分率（left ventricular ejection fraction, LVEF）降低有關，此外，此群體亦表現出體重較低、三酸甘油脂與血小板數較低、鹼性磷酸酶較高，以及較高的周邊動脈疾病盛行率。與無MR者相比，中重度MR患者在調整臨床變項後，MACEs、心血管及整體死亡風險顯著增加（調整後風險比[aHR]分別為2.18、4.57、4.59；95%信賴區間為1.02–4.67、1.40–14.94、1.60–13.20）。追蹤期間內，中重度MR在統計上仍為上述預後的重要風險因子（log-rank檢定，p < 0.05）。在輕度MR患者中，LVEF低於50%者之MACEs風險顯著升高。結論：中重度MR顯著增加慢性HD患者發生MACEs、心血管死亡及整體死亡之風險；而在輕度MR患者中，LVEF <50% 為MACEs的重要預測因子。

Background: This study aims to assess mitral regurgitation (MR) severity’s correlation with patients’ clinical and cardiac status, along with its association with cardiovascular outcomes and overall mortality in hemodialysis (HD) patients. Methods: A total of 238 adult chronic HD patients with echocardiography records from October to December 2018 were enrolled in the study and were followed until the end of 2021, transfer, or death. Mitral regurgitation (MR) severity was defined by effective regurgitant orifice area: <0.2 cm² (mild), 0.2–0.4 cm² (moderate), and ≥0.4 cm² (severe). Patients were grouped as none, mild, and moderate-to-severe MR. Association of MR severity with major adverse cardiovascular events (MACEs), cardiovascular, and overall mortality was evaluated, with additional risk factors ex-plored through subgroup analysis. Results: Among 238 HD patients, 48 had no MR, 157 had mild MR, and 33 had moderate-to-severe MR. Those with moder-ate-to-severe MR showed more left ventricular (LV) hypertrophy, higher inferior vena cava diameter, and lower LV ejection fraction (LVEF), exhibited lower body weight, triglycerides, platelets, and higher alkaline-phosphatase and peripheral arte-rial disease prevalence. Compared to no MR, moderate-to-severe MR increased the risk of MACEs, cardiovascular, and overall mortality (adjusted HRs: 2.18, 4.57, 4.59; 95% CI: 1.02–4.67, 1.40–14.94, 1.60–13.20, respectively). These risks remained sig-nificant during follow-up (log-rank p < 0.05). For mild MR patients, LVEF <50% significantly increased MACEs risk. Conclusion: Moderate-to-severe MR increases MACEs, cardiovascular and overall mortality risk in chronic HD patients. An LVEF <50% is a key determinant for MACEs in mild MR patients.