BMJ  2005;330:498 (5 March), doi:10.1136/bmj.330.7490.498-a

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Measuring mitral regurgitation predicts clinical outcome of treatment

New York

Quantitative grading of mitral regurgitation, based on the effective regurgitant orifice of the valve and the regurgitated volume of blood, is a powerful predictor of the clinical outcome of medical management in asymptomatic patients, suggests a new study. Patients with an effective regurgitant orifice of 40 mm² or more should be considered for surgical repair, say the authors.

The study found that the predictive power of an increasing effective regurgitant orifice (adjusted risk ratio per increment of 10 mm², 1.18; 95% confidence interval 1.06 to 1.30; P<0.01) superseded all other qualitative and quantitative measures of regurgitation ( New England Journal of Medicine2005 ;352: 875-83[Abstract/Free Full Text]).

Compared with patients with a regurgitant orifice of less than 20 mm², those with an orifice of 40 mm² or more had an increased risk of death from any cause (adjusted risk ratio 2.90; 95% confidence interval 1.33 to 6.32; P<0.01), death from cardiac causes (5.21; 1.98 to 14.40; P<0.01), and cardiac events (5.66; 3.07 to 10.56; P<0.01).

In patients with an effective regurgitant orifice of 40 mm² or more the five year probability of death or late cardiac surgery was 84%, suggesting that surgery is almost inevitable. Patients with an effective regurgitant orifice of 20-39 mm² had complication rates that were initially low but subsequently rose over time.

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