ArticleHeart (British Cardiac Society)2025
Mortality associated with moderate and severe mitral regurgitation in 608 570 men and women undergoing echocardiography.
Article in Heart (British Cardiac Society), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Prognostic Significance of the Modified H2FPEF Score in Patients with Severe Primary Mitral Regurgitation.Journal of cardiovascular development and disease · 2026Article
- Natural History and Outcomes of Patients With Moderate and Moderate-Severe Mitral Regurgitation.JACC. Advances · 2026Article
- Rationale and Design of the SMILE Registry: A Comprehensive Approach to Predicting Treatment Outcomes in Mitral Regurgitation.Journal of clinical medicine · 2026Article
- Clinical research and trials in echocardiography: rationale, requirements and future opportunities.Echo research and practice · 2025Review
- A "Watchful Surgery" Approach: Timing and Valve Choice for Mildly Symptomatic Mitral and Aortic Valve Disease.Journal of surgery and research · 2025Article
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Authors and funding
9 authors.
Funding
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Abstract
backgroundAlthough the prognostic implications of severe mitral regurgitation (MR) are well recognised, they are less clear in moderate MR. We therefore explored the prognostic impact of both moderate and severe MR within the large National Echocardiography Database Australia cohort.
methodsEchocardiography reports from 608 570 individuals were examined using natural language processing to identify MR severity and leaflet pathology. Atrial (aFMR) or ventricular (vFMR) functional MR was assessed in those without reported leaflet pathology. Using individual data linkage over median 1541 (IQR 820 to 2629) days, we examined the association between MR severity and all-cause (153 612/25.2% events) and cardiovascular-related mortality (47 840/7.9% events).
resultsThere were 319 808 men and 288 762 women aged 62.1±18.5 years, of whom 456 989 (75.1%), 102 950 (16.9%), 38 504 (6.3%) and 10 127 (1.7%) individuals had no/trivial, mild, moderate and severe MR, respectively, reported on their last echo. Compared with those with no/trivial MR (26.5% had leaflet pathology, 19.2% died), leaflet pathology (51.8% and 78.9%, respectively) and actual 5-year all-cause mortality (54.6% and 67.5%, respectively) increased with MR severity. On an adjusted basis (age, sex and leaflet pathology), long-term mortality was 1.67-fold (95% CI 1.65 to 1.70) and 2.36-fold (95% CI 2.30 to 2.42) higher in moderate and severe MR cases (p<0.001) compared with no/trivial MR. The prognostic pattern for moderate and severe MR persisted for cardiovascular-related mortality and within prespecified subgroups (leaflet pathology, vFMR or aFMR, and age<65 years).
conclusionsWithin a large real-world clinical cohort, we confirm that conservatively managed severe MR is associated with a poor prognosis. We further reveal that moderate MR is associated with increased mortality, irrespective of underlying aetiology.
trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12617001387314).
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