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Disproportionate Left Ventricular Enlargement in Mitral Valve Prolapse: Prevalence, Predictors, and Association With
Yan Topilsky1, Benjamin Essayagh2,3, Giovanni Benfari2
1Department of Cardiology Tel Aviv Medical Center and Sackler Faculty of Medicine Tel Aviv Israel.
Journal of the American Heart Association
|July 17, 2025
Summary
Left ventricular end-systolic enlargement (LVESD ≥40mm) in less-than-severe mitral regurgitation (MR) is common and linked to worse survival. Early surgery in moderate MR with LVESD ≥40mm improves outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Severe degenerative mitral regurgitation (MR) triggers surgery based on left ventricular (LV) enlargement.
- The prevalence and survival impact of disproportionate LV enlargement in less-than-severe MR remain unclear.
Purpose of the Study:
- To analyze the prevalence of disproportionate LV enlargement in patients with less-than-severe degenerative MR.
- To determine the association of this enlargement with mortality and the impact of early surgery.
Main Methods:
- A multicenter international study of 2848 patients with mild or moderate degenerative MR.
- Primary endpoint: survival under medical management. Secondary endpoint: survival after early mitral surgery (within 3 months).
Main Results:
- LV end-systolic diameter (LVESD) ≥40mm was the sole independent predictor of reduced survival (5-year survival 70% vs 76%, P=0.009).
- LVESD ≥40mm was linked to larger body size, regurgitation, left atrium size, male sex, and diabetes.
- In moderate MR with LVESD ≥40mm, early surgery (22% of cases) significantly improved survival (aHR 0.11, P=0.002).
Conclusions:
- Disproportionate LV enlargement (LVESD ≥40mm) is common in less-than-severe degenerative MR and independently predicts worse survival.
- LVESD ≥40mm serves as a crucial risk stratification marker for patients not typically considered for intervention.
- Early mitral surgery in select moderate MR patients with LVESD ≥40mm improves survival.
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