Prognosis of combined moderate aortic stenosis and moderate mitral regurgitation

Introduction Aortic stenosis (AS) is the most common valvular disease requiring intervention while mitral regurgitation (MR) is the most common valvular disease. Although combined moderate disease is frequently coexisting, clinical evidence about this group prognosis is lacking. Purpose We aimed to evaluate long-term mortality in patients with combined moderate AS and moderate MR. Methods This retrospective observational cohort study included patients who undergone echocardiography at a large tertiary medical center between 2009 and 2025. Clinical and echocardiography data were collected. We identified patients with moderate AS and moderate MR as defined by the valvular guidelines. For survival analysis, additional groups of patients were identified: I - severe AS and moderate MR, II - severe AS and severe MR, III - severe AS with no MR. The primary endpoint was all-cause mortality. Survival was analyzed using Kaplan–Meier estimates and Cox proportional hazards models adjusted for age, sex, BMI, left ventricular ejection fraction (EF), atrial fibrillation (AF), kidney disease (CKD). Results A total 3,049 patients were included: 119 with moderate AS and moderate MR (age 80±10 years, 34% female); 161 with severe AS and moderate MR (age 82±10 years, 65% females); 99 with severe AS and severe MR (age 81±11 years, 63% females); and 2,670 with severe AS and no significant MR (age 77±11 years, 47% females). Over a median follow-up of 3 years, 1,475 deaths (48%) occurred. All-cause mortality of patients with moderate AS and moderate MR was comparable to patients with severe AS and moderate MR. However, mortality was better compared to severe AS and severe MR group and worst then severe AS with no MR group (Figure 1). In cox analysis: all groups maintained increased mortality (with reference to severe AS and no MR group) after adjustment to age and sex, blood pressure and BMI, presence of AF and CKD as well as EF (Figure 2). In general, the moderate AS and moderate MR group showed lower HR compared to severe AS and severe MR group but higher than severe AS moderate MR group. Conclusion Concomitant moderate AS and moderate MR disease is associated with significantly higher mortality than severe AS with no MR. These finding suggest that this group represents a higher-risk patients population that may require close surveillance and earlier therapeutic consideration.