Natural History and Outcomes of Patients With Moderate and Moderate-Severe Mitral Regurgitation.

Authors

Abdullah Al-Abcha, Ghasaq Saleh, Salameh Al-Halaseh, Jwan Naser, Trevor Simard, Jeremy Thaden, Sorin Pislaru, Mackram Eleid, Mayra Guerrero, Mohamad Alkhouli, Charanjit S Rihal, Ratnasari Padang, Benjamin Hibbert

Published in

JACC. Advances. Volume 5. Issue 8. Pages 103057. Jul 23, 2026. Epub Jul 23, 2026.

Abstract

The natural history of mitral regurgitation (MR) in contemporary practice remains poorly defined.
The purpose of this study was to quantify clinical outcomes of patients with moderate and moderate-severe MR.
We conducted a retrospective cohort study of consecutive patients with moderate or moderate-severe MR who underwent echocardiography at Mayo Clinic between 2010 and 2023. MR was classified as degenerative or functional. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF) hospitalization, MR progression to severe MR, and mitral valve intervention.
Of 8,687 patients (mean age 70.7 ± 13.7 years; 45.1% female), 21.4% had degenerative MR and 78.6% had functional MR, and median follow-up was 4.1 years (Q1-Q3: 2.3-7.9). At 4 years, overall survival was 68.5% (95% CI: 67.4%-69.7%), with higher survival in patients with degenerative MR (84.1%; 95% CI: 81.9%-86.3%) compared to functional MR (65.0%; 95% CI: 63.7%-66.3%), and the cumulative incidence of HF hospitalization was higher in functional MR (36.8%; 95% CI: 35.6%-38.1%) than degenerative MR (17.9%; 95% CI: 15.7%-20%). However, the risk of death and HF hospitalization was similar after multivariable adjustments. MR progression occurred in 32.7% (95% CI: 31.0%-34.4%), less commonly in functional MR (adjusted HR: 0.65; 95% CI: 0.54-0.79; P < 0.001). Mitral valve intervention was infrequent (11.4%; 95% CI: 10.6%-12.1%) and significantly less common in functional MR (adjusted HR: 0.45; 95% CI: 0.37-0.56; P < 0.001).
Patients with moderate or moderate-severe MR accrue significant mortality and morbidity over follow-up. Further trials are needed to ascertain the indication, optimal timing and method of procedural intervention.

PMID:
42492126
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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