© JACOPIN/BSIP/SPL
January/February 2025
Moderate mitral regurgitation: study recommends proactive follow up
By Rebecca Jenkins
Moderate mitral regurgitation (MR) is associated with increased mortality, irrespective of a person’s age or underlying aetiology, a large Australian clinical cohort study finds.
The prognostic implications of severe MR were already well recognised, researchers wrote in Heart, but they were less clear in moderate MR.
Although MR severity is routinely reported in echocardiographic reports, general clinical consensus is that nonsevere MR is a benign condition, not requiring any specific recommendations or follow up unless it becomes severe, the researchers explained.
For the study, the researchers used information collected from the National Echocardiography Database Australia (NEDA), a multicentre observational registry that captures standardised echocardiographic data of adults referred for routine cardiac investigation from across a range of settings Australia-wide. They used natural language processing to identify MR severity and leaflet pathology in echocardiography reports from more than 600,000 individuals in the NEDA cohort.
Overall, 75.1% of people had no/trivial MR reported on their last echocardiography study, 16.9% had mild MR, 6.3% had moderate MR and 1.7% had severe MR. Leaflet pathology was common – present in 26.3% of individuals with no/trivial MR and as high as 78.9% in severe MR.
Using individual data linkage over a median of 1541 days of follow up, the research team examined the association between MR severity and all-cause and cardiovascular-related mortality events.
After adjusting for age, sex and leaf let pathology, they found long-term mortality was 1.67-fold higher in moderate MR and 2.36-fold higher in severe MR.
Lead author Professor David Playford, Professor of Cardiology at the University Notre Dame, Fremantle, Western Australia, told Medicine Today that the findings showed that moderate MR was not a benign condition, supporting the need for routine reporting of MR severity.
‘Our recommendation from these data is that patients with MR are routinely followed up, and in the setting of less-than-severe MR, patients need routine follow-up echocardiography to establish whether the MR is worsening,’ he said.
Professor Playford, who is the Principal Investigator of the NEDA, said that apart from tracking severity, repeat echocardiography was very helpful to assess whether cardiac phenotypic changes, such as ventricular dilatation and/or dysfunction, atrial fibrillation or pulmonary hypertension, have occurred.
Since both moderate and severe MR were associated with premature mortality, both conditions should prompt referral for cardiology review.
‘Severe MR routinely requires cardiology review and an active multidisciplinary discussion around appropriateness of intervention, and if indicated, then the best approach/intervention,’ he said.
‘Because of the poor outcomes in untreated severe MR, early cardiology referral and follow up is recommended, even in apparently asymptomatic individuals.’
It was hoped future studies would establish whether therapeutic strategies could improve outcomes in patients with moderate MR.
‘We do not yet recommend intervention in moderate MR unless it is being performed in association with another intervention, such as coronary artery bypass or aortic valve replacement,’ Professor Playford said.