Cardiac Damage Staging Classification in Asymptomatic Moderate or Severe Primary Mitral Regurgitation

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Optimal intervention timing is unclear for asymptomatic patients with primary mitral regurgitation (MR).
• Assessing prognostic value of a novel cardiac damage staging classification is crucial for this patient group.

Purpose of the Study:

• To evaluate the prognostic significance of a new cardiac damage staging classification.
• To assess its value in asymptomatic patients with moderate to severe primary mitral regurgitation (MR).

Main Methods:

• Retrospective analysis of prospectively collected data from 338 asymptomatic patients with moderate/severe primary MR.
• Hierarchical classification into stages 0-4 based on cardiac damage severity (ventricular, atrial, pulmonary vasculature, tricuspid valve, right ventricle).
• Analysis of 10-year mortality rates and composite outcomes, adjusted for clinical risk factors and EuroSCORE II.

Main Results:

• A significant stepwise increase in 10-year mortality rates was observed across stages 0-4 (20.0% to 61.3%).
• The staging classification independently predicted mortality (HR=1.41) and cardiovascular mortality/hospitalization (HR=1.51) per stage increase.
• The classification demonstrated incremental prognostic value over existing clinical variables (NRI=0.40, p=0.03).

Conclusions:

• A novel staging classification for cardiac damage offers independent prognostic value in asymptomatic moderate/severe primary MR.
• This classification provides incremental predictive information, aiding in risk stratification and potential intervention timing.