Valvular & structural heart disease
Severe Mitral Regurgitation in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis
Authors' conclusion
Severe MR in paradoxical low-flow, low-gradient severe aortic stenosis is associated with adverse outcomes and distinctive left ventricular remodeling. Aortic valve replacement improves survival across all MR grades, with greater impact in severe MR.
Study context
- Population
- Patients with paradoxical low-flow, low-gradient severe aortic stenosis (aortic valve area ≤1.0 cm 2, mean gradient <40 mm Hg, left ventricular ejection fraction ≥50%, Q ≤210 mL/s)
- Participants
- 1,189 patients
- Exposure
- Severe vs non-severe mitral regurgitation (MR)
- Severe MRn = 80
- Non-severe MRn = 1,109
- Outcome
- Left ventricular characteristics
Main finding
As reported in the abstract
- Severe MR: lower flow rates, increased left ventricular dimensions, more eccentric hypertrophy pattern compared with non-severe MR
Observational data: associations, not effects.
Further findings
| Outcome | Hazard ratio | P value |
|---|---|---|
| All-cause mortality and composite outcome, multivariable adjustedSevere MR · all-cause mortality · multivariable adjustment | 1.43 | P = 0.011 |
| All-cause mortality and composite outcome, multivariable adjustedSevere MR · composite outcome · multivariable adjustment | 1.64 | P < 0.001 |
| Mortality with aortic valve replacementIn severe MR | 0.18 | P < 0.001 |
- Mortality with aortic valve replacement: Propensity-adjusted models: stronger aortic valve replacement impact with increasing MR degree (P interaction =0.044)
All-cause mortality and aortic valve replacement rates · follow-up of up to 5 years
- Higher all-cause mortality with severe MR
- P = 0.02
- Higher aortic valve replacement rates with severe MR
- P = 0.012
Mortality with aortic valve replacement
- Aortic valve replacement significantly reduced mortality at every MR degree
Original publication
Severe Mitral Regurgitation in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis. Circ Cardiovasc Imaging. Published 21 March 2025. doi:10.
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