MITRAL regurgitation severity was associated with long-term survival among asymptomatic patients, with higher effective regurgitant orifice area linked to a progressively greater risk of mortality over up to 34 years of follow-up.
Researchers evaluated the long-term prognostic value of baseline mitral regurgitation severity in a prospective cohort of 449 asymptomatic patients with holosystolic degenerative mitral regurgitation.
Participants were enrolled between 1991 and 2000 and followed through May 2025, with a median follow-up of 26 years and a maximum follow up of 34 years. The mean age of participants was 64 years, and 62% were male.
The study assessed severity using effective regurgitant orifice area. At baseline, 127 patients had an effective regurgitant orifice area below 20 mm², 128 had values of 20 to 39 mm², and 194 had values of at least 40 mm².
During follow-up, 254 patients underwent mitral valve surgery.
The 10-year cumulative incidence of surgery increased markedly across severity categories: 18% among patients with an effective regurgitant orifice area below 20 mm²; 64% for those with values of 20 to 39 mm²; and 88% for those with values of at least 40 mm².
Among patients managed medically, survival declined as effective regurgitant orifice area increased.
Five-year survival rates were 88% for those with an effective regurgitant orifice area below 20 mm², 72% for those with values of 20 to 39 mm², and 55% for those with values of at least 40 mm².
When investigators extended the analysis to include outcomes after surgery, differences in survival between patients who underwent surgery and those who did not became more pronounced as effective regurgitant orifice area increased.
The association between surgery and improved survival emerged at effective regurgitant orifice area values above 30 mm².
Notably, patients with upper moderate mitral regurgitation, defined as an effective regurgitant orifice area of 30 to 39 mm², demonstrated a significant association between surgical treatment and improved long-term survival.
The findings suggest that assessment of mitral regurgitation severity through quantified effective regurgitant orifice area may help identify patients at increased long-term risk and support management decisions that integrate imaging findings, ventricular response, and clinical characteristics.
Reference
Karadzha A et al. Twenty-Five–Year Follow-Up of Quantified Mitral Regurgitation. JAMA Cardiol. 2026;DOI:10.1001/jamacardio.2026.2389
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