Risk Stratification in Severe and Asymptomatic Mitral Valve Insufficiency: How Could Patients with Adverse Outcomes Be Identified?

Objective To assess the usefulness a score which might identify adverse outcomes in asymptomatic patients with severe organic mitral valve regurgitation using clinical, echocardiographic and exercise variables. Material and Methods We assessed 375 asymptomatic patients with severe organic mitral valve regurgitation (61±10 years, left ventricular ejection fraction [LVEF] 67%±5%). The score performed included the presence of atrial fibrillation, end-diastolic diameter e”40 mm, effective regurgitant orifice 55 mm 2 , left atrium volume >120 cm 3 , age >60, and exercise time 5% or LVEF 3 was 2.3%, 26% and 78%, respectively. Primary event rate with a score 3 was 2.3%±0.1%, 28%±4% and 73%±9%, respectively. The area under the ROC curve was 0.87. Conclusion In asymptomatic patients with severe mitral valve regurgitation, a score using clinical, echocardiographic and exercise variables is useful to identify subgroups of patients at greater long-term risk.