Prognostic Implications of Mitral Regurgitation in Patients With Severe Aortic Regurgitation

Abstract

Background— Mitral regurgitation (MR) is common in those with severe aortic regurgitation (AR) and can predispose to atrial fibrillation, heart failure, and a need for mitral valve surgery during aortic valve replacement (AVR). However, little data exist as to its clinical and prognostic implications. Methods and Results— Search of our echocardiographic data base between 1993 and 2007 yielded 756 patients with severe AR. with comprehensive clinical data from chart review and mortality data from National Death Index. Mortality was analyzed as a function of MR severity. Effect of AVR and concomitant mitral valve repair were investigated. Patient characteristics were age, 61±17 years; female sex, 41%; and ejection fraction, 54±19%. MR grade ≥2+ was present in 343 (45%) patients: 2+ in 152 (20%), 3+ in 93 (12%), and 4+ in 98 (13%). There was a progressive decrease in survival with each grade of MR ( P <0.0001). Performance of AVR was associated with a better survival in those with 3 or 4+ MR ( P =0.02). In addition, concomitant mitral valve repair in these patients resulted in a better survival (hazard ratio, 0.29; P =0.02). Conclusions— MR is common in patients with severe AR, with 3 or 4+ MR occurring in a quarter of these patients. It is an independent predictor of reduced survival. Performance of AVR and concomitant mitral valve repair is associated with a better survival. Development of MR should serve as an indication for AVR even in asymptomatic patients.