ArticleJACC. Advances2026
Natural History and Outcomes of Patients With Moderate and Moderate-Severe Mitral Regurgitation.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe natural history of mitral regurgitation (MR) in contemporary practice remains poorly defined.
objectivesThe purpose of this study was to quantify clinical outcomes of patients with moderate and moderate-severe MR.
methodsWe conducted a retrospective cohort study of consecutive patients with moderate or moderate-severe MR who underwent echocardiography at Mayo Clinic between 2010 and 2023. MR was classified as degenerative or functional. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF) hospitalization, MR progression to severe MR, and mitral valve intervention.
resultsOf 8,687 patients (mean age 70.7 ± 13.7 years; 45.1% female), 21.4% had degenerative MR and 78.6% had functional MR, and median follow-up was 4.1 years (Q1-Q3: 2.3-7.9). At 4 years, overall survival was 68.5% (95% CI: 67.4%-69.7%), with higher survival in patients with degenerative MR (84.1%; 95% CI: 81.9%-86.3%) compared to functional MR (65.0%; 95% CI: 63.7%-66.3%), and the cumulative incidence of HF hospitalization was higher in functional MR (36.8%; 95% CI: 35.6%-38.1%) than degenerative MR (17.9%; 95% CI: 15.7%-20%). However, the risk of death and HF hospitalization was similar after multivariable adjustments. MR progression occurred in 32.7% (95% CI: 31.0%-34.4%), less commonly in functional MR (adjusted HR: 0.65; 95% CI: 0.54-0.79; P < 0.001). Mitral valve intervention was infrequent (11.4%; 95% CI: 10.6%-12.1%) and significantly less common in functional MR (adjusted HR: 0.45; 95% CI: 0.37-0.56; P < 0.001).
conclusionsPatients with moderate or moderate-severe MR accrue significant mortality and morbidity over follow-up. Further trials are needed to ascertain the indication, optimal timing and method of procedural intervention.
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