Key result
Transcatheter aortic valve replacement was followed by persistent significant mitral regurgitation in 19.6% of patients at one year, predicted by older age, female sex, and higher MAC scores.
Why the study?
Mitral regurgitation is a common comorbidity in patients undergoing TAVR that influences long-term outcomes, but the impact of TAVR on MR remains complex and not fully understood.
What are the risk factors for persistent significant mitral regurgitation at one year following TAVR?
Cohort (n=586)
No
What are the risk factors for persistent significant mitral regurgitation at one year following TAVR?
Effect estimate: AUC 0.59 (95% CI 0.55-0.64)
Older age, female sex, and higher mitral annular calcification scores are modest predictors of persistent significant mitral regurgitation one year after TAVR.
Background Mitral regurgitation (MR) is a common comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR), with its persistence or improvement influencing long-term outcomes. While TAVR primarily addresses aortic stenosis, its impact on MR remains complex and not fully understood. Purpose This study aims to analyze the evolution of MR following TAVR, identify factors associated with its regression or persistence, and improve patient management strategies. Methods We conducted a retrospective analysis of 586 patients who underwent TAVR at a tertiary care center between 2017 and 2023. Baseline clinical, echocardiographic, and tomographic parameters were assessed to evaluate changes in significant (moderate or severe) MR one-year post-procedure. Results The cohort had a mean age of 82.4 (SD 5.8) years, with 59% (343) being female. Comorbidities were prevalent: 84% (494) had hypertension, 41% (237) coronary artery disease, and 38% (223) diabetes. Mean left ventricular ejection fraction (LVEF) was 59.7% (SD 9.7), and global longitudinal strain (GLS) was -15% (SD 4.96). Pre-TAVR, 21.6% (126) had significant MR. Most patients had some degree of mitral annular calcification (MAC), with a median mitral calcium score of 1548 (IQR 440-4079) and a median MAC score of 4 (IQR 2-6). At one-year follow-up, significant MR persisted in 19.6% (115) of patients. Logistic regression identified older age, female sex, and higher mitral calcium and MAC scores as predictors of persistent MR. A MAC score >4 had a sensitivity of 64% and specificity of 52%, with an area under the receiver operating characteristic (ROC) curve of 0.59 (95% CI 0.55–0.64), indicating modest predictive value. Conclusions One in five TAVR patients had persistent significant MR at one year. Older age, female sex, and higher MAC scores were associated with MR persistence, which may aid in risk stratification and personalized treatment planning in patients with both aortic and mitral valve disease.TAVR Patient Characteristics MR and Mitral CS 1y after TAVR
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Cruz et al. (2025) conducted a cohort in Aortic stenosis and mitral regurgitation (n=586). Transcatheter aortic valve replacement (TAVR) was evaluated on Persistent significant (moderate or severe) mitral regurgitation (AUC 0.59, 95% CI 0.55-0.64). Transcatheter aortic valve replacement was followed by persistent significant mitral regurgitation in 19.6% of patients at one year, predicted by older age, female sex, and higher MAC scores.
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