A novel echocardiographic risk score for mortality in primary mitral regurgitation surgery

Background Despite the availability of several risk scores for cardiac surgery in primary mitral regurgitation (PMR), accurately predicting adverse events remains challenging. Purpose This study aimed to develop a new predictive score for postoperative mortality by incorporating advanced functional echocardiographic parameters. Methods We conducted a retrospective analysis of a prospective cohort of PMR patients who underwent mitral valve surgery at a tertiary care center between 2014 and 2022. Echocardiographic data from studies performed within six months before surgery were analyzed. One-year and long-term mortality were assessed using logistic and Cox regression models to identify significant predictors of outcomes. Results A total of 349 patients were included (median EuroSCORE II: 2.3 [1.1–5.0]; mean age: 68.5 ± 12.4 years; 55.9% male). Mean left ventricular ejection fraction (LVEF) was 60% ± 9.4%. Mean follow-up was 3.28 ± 2 years. One-year mortality occurred in 29 patients (8.3%), while all-cause mortality during follow-up was 59 patients (16.9%). Patients who died within the first year were older and had significantly lower left atrial reservoir (LAr) strain, higher right ventricular systolic pressure (RVSP), and reduced right ventricular-arterial coupling (RVAc) (Figure 1). Multivariable regression analysis identified the following independent predictors of mortality:• RVAc < 0.50• LAr strain < 20%• LVEF < 60%• Age > 65 years• Preoperative symptoms The risk model stratified patients into quartiles, with an area under the ROC curve of 0.830 (95% CI 0.774–0.885) for 1-year mortality and 0.832 (95% CI 0.781–0.884) for long-term mortality (Figure 2). Conclusions A novel predictive score integrating left atrial and ventricular function along with right ventricular-arterial coupling effectively predicts all-cause mortality in PMR patients undergoing surgery. External validation is needed to confirm its clinical utility.