Quantitative Determinants of the Outcome of Asymptomatic Mitral Regurgitation

Most patients with mitral regurgitation are asymptomatic at diagnosis, and the optimal timing of or need for mitral-valve surgery is uncertain. This study shows that the use of Doppler echocardiography to quantify mitral regurgitation accurately predicts the clinical outcome. Patients with an effective regurgitant orifice of 40 mm 2 or more have an increased risk of death and should promptly be considered for surgery even if they have no symptoms. These findings could have a substantial effect on clinical practice. The use of Doppler echocardiography to quantify mitral regurgitation accurately predicts the clinical outcome. Patients with an effective regurgitant orifice of 40 mm 2 or more have an increased risk of death and should promptly be considered for surgery. Mitral-valve regurgitation is common, 1 and its prevalence increases with age. 1 The management of mitral regurgitation and indications for surgery are controversial. 2 Previous outcome studies showed that patients with organic mitral regurgitation who have symptoms or a reduced ejection fraction are at high risk, 3 , 4 warranting mitral surgery. 2 Conversely, the clinical outcome among patients with asymptomatic mitral regurgitation is poorly defined, and criteria defining high-risk subgroups are uncertain. 2 Such subgroups are important to identify as technical improvements in surgery 5 , 6 — decreased operative mortality 7 and increased repair rates 8 — allow the restoration of patients' life expectancy. 9 Thus, surgery may be warranted . . .