Key result
Regurgitant fraction ≥50% improves risk prediction over EROA and regurgitant volume in secondary MR.
Why the study?
Although EROA predicts outcome, comparative studies evaluating the prognostic value of PISA-derived MR severity parameters in secondary MR are limited.
Does regurgitant fraction provide incremental prognostic value over effective regurgitant orifice area and regurgitant volume in patients with secondary mitral regurgitation?
Cohort (n=186)
No
Does regurgitant fraction provide incremental prognostic value over effective regurgitant orifice area and regurgitant volume in patients with secondary mitral regurgitation?
p-value: p=0.002
In patients with secondary mitral regurgitation, combining regurgitant fraction with effective regurgitant orifice area significantly improves risk prediction for death or heart failure hospitalization, particularly by restratifying risk in those with EROA <40 mm2.
May refine risk stratification in secondary MR; leaves open need for prospective validation before guiding therapy.
Background Quantitative parameters of mitral regurgitation (MR), such as effective regurgitant orifice area (EROA), regurgitant volume (RegVol) and regurgitant fraction (RF), assessed by the proximal isovelocity surface area (PISA) method, are recommended measures of MR severity. Although studies have demonstrated that EROA is a predictor of outcome, comparative studies are limited. Purpose The aim of the study was to compare the prognostic value of parameters of MR severity derived from the PISA method in patients with secondary MR. Methods We retrospectively analysed 186 patients who consecutively underwent a comprehensive echocardiographic examination at out department in 2019 and had been diagnosed with more than mild secondary MR. Quantitative parameters of MR severity were separately reported: EROA, RegVol and RF by the PISA method. The clinical outcome was a composite of all-cause death or hospitalisation due to heart failure between the echocardiographic examination and the end of 2023. Results During the median follow-up of 769 (106-1584) days, 107 patients reached the composite endpoint. By univariate Cox regression, EROA ≥40mm2 and RF ≥50% were strongly associated with the combined clinical endpoint, while RegVol ≥60 ml showed no significant association. Adding either EROA≥40mm2 or RF≥50% to the baseline model (including age, left ventricular end-systolic volume index, stroke volume index, right ventricular diameter and pulmonary systolic pressure) enhanced the model’s association with the combined clinical outcome (Pannel A). Including both EROA and RF in the same model significantly improved its performance compared to using either EROA ≥40mm2 or RF ≥50% alone (Panel A). Kaplan-Meier curve showed that patients with both EROA <40mm2 and RF ≥50% had a significantly higher risk of the composite endpoint than patients with both EROA <40mm2 and RF <50% (log rank p=0.002) (Panel B). Furthermore, patients with both EROA <40mm2 and RF ≥50% showed event rates similar to those with EROA ≥40 mm2 (log rank p=0.055). Conclusions In patients with secondary MR, EROA and RF demonstrated superior prognostic value compared to RegVol, and their combination significantly improved risk prediction. Our results indicated that RF could be used for risk restratification especially in patients with EROA <40 mm2.Figure
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Ambrožič et al. (2026) conducted a cohort in secondary mitral regurgitation (n=186). Regurgitant fraction (RF) ≥50% and effective regurgitant orifice area (EROA) ≥40mm2 vs. Regurgitant fraction <50% and EROA <40mm2 was evaluated on composite of all-cause death or hospitalisation due to heart failure (p=0.002). In secondary mitral regurgitation, patients with EROA <40mm2 and regurgitant fraction ≥50% had a significantly higher risk of death or heart failure hospitalization than those with RF <50% (p=0.002).
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