Survival of patients with mild secondary mitral regurgitation with and without mild tricuspid regurgitation.

Abstract Background Mild secondary mitral regurgitation (SMR) is considered clinically benign when left ventricular ejection fraction (LVEF) is preserved, but evidence on survival associated with mild SMR in normal LVEF is limited. Methods We conducted a retrospective cohort study of patients who underwent echocardiogram in a healthcare network between 2013 and 2018. We compared the survival of 4 groups: no valvular abnormalities (group 1), trace SMR with trace or mild TR (group 2), mild SMR with trace or no TR (group 3), and mild SMR with mild TR (group 4). A Cox proportional hazard model evaluated hazard of death in groups 2-4 compared with group 1, adjusting for demographics, comorbidities, and LVEF. The same comparisons were repeated in a subgroup of patients with preserved LVEF. Results Among the 16,372 patients of mean age 61 (51-71) years and 48% women, there were 8,132 (49.7%) group 1 patients, 1,902 (11.6%) group 2 patients, 3,017 (18.4%) group 3 patients, and 3,321 (20.3%) group 4 patients. Compared with group 1, group 4 had significantly increased adjusted hazard of death (hazard ratio [HR]:1.21 (95% confidence interval [CI]1.12-1.31), p Conclusions Mild SMR with mild TR, irrespective of LVEF, was associated with worse survival compared with patients without any valvular abnormalities. Patients with mild SMR may require closer monitoring even with normal LVEF.