Prognostic implication of valvular lesion and left ventricular size in asymptomatic patients with chronic organic mitral regurgitation and normal left ventricular performance

The goal of this study was to determine the presence of independent predictors of symptomatic progression, and/or left ventricular dysfunction in asymptomatic patients with severe mitral regurgitation. We prospectively evaluated 128 consecutive patients (mean age 60 ± 8 years, 68% male; ejection fraction 66 ± 3%). During follow-up (mean 29 ± 12 months).The end point occurred in 37 patients (29%). Multivariate analysis using Cox model identified the effective regurgitant orifice area (EROA) >55 mm2 (RR: 6.3; 95% CI: 2.3-8.1; P < .001) and an end-systolic diameter (ESD) >22 mm/m2 (RR: 4.5; 95%CI: 1.8-9.4; P < .02) as the only independent predictors of the end point. When the follow-up data were added, the annualized change rate of the EROA (>15 mm2/year) was independently associated with the end point. In asymptomatic patients with organic mitral regurgitation, the EROA and ESD at study entry were independent predictors of the combined end point and allowed a better risk stratification in this group of patients.