{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T12:41:07Z","timestamp":1794487267522,"version":"4.9.1"},"reference-count":17,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n Current guidelines recommend consideration of surgical treatment for asymptomatic patients with severe mitral valve regurgitation, but the long-term prognosis and optimal treatment of those with moderate mitral regurgitation (MR) remain uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the long-term prognostic value of baseline MR severity and the association of surgery with survival outcomes in asymptomatic patients.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a prospective cohort study with extended follow-up among 449 asymptomatic patients with holosystolic degenerative MR enrolled between January 1991 and November 2000 and followed up with through May 2025 (median [IQR] follow-up, 26 [14-29] years; maximum, 34 years) at a single tertiary referral center (the Mayo Clinic, Rochester, Minnesota).<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Baseline MR severity quantified by effective regurgitant orifice area (ERO). Patients were monitored under medical therapy and, when applicable, after subsequent surgical correction.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n All-cause mortality, assessed according to baseline ERO using Cox proportional hazards models adjusted for cardiovascular risk factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 449 patients included, the mean (SD) age was 64 (14) years, and 278 participants (62%) were male. At baseline, 127 patients (28%) had ERO &amp;lt;20 mm\n 2<\/jats:sup>\n , 128 (28%) had ERO 20-39 mm\n 2<\/jats:sup>\n , and 194 (43%) had ERO \u226540 mm\n 2<\/jats:sup>\n . During follow-up, 254 patients (57%) underwent mitral valve surgery. Ten-year cumulative incidence of surgery was 18% for ERO &amp;lt;20 mm\n 2<\/jats:sup>\n , 64% for 20-39 mm\n 2<\/jats:sup>\n , and 88% for \u226540 mm\n 2<\/jats:sup>\n . Survival of medically treated patients declined progressively with increasing ERO category (5-year rate: 88% [&amp;lt;20 mm\n 2<\/jats:sup>\n ], 72% [20-39 mm\n 2<\/jats:sup>\n ], and 55% [\u226540 mm\n 2<\/jats:sup>\n ];\n P<\/jats:italic>\n \u2009=\u2009.01), and multivariable analysis confirmed the incremental risk of higher ERO on a continuous scale (adjusted hazard ratio per IQR increase, 2.53; 95% CI, 1.30-4.93;\n P<\/jats:italic>\n \u2009=\u2009.01). When extending the analysis through subsequent surgical follow-up, the survival difference between patients who did vs did not undergo operation widened with ERO (\u03c7\n 2<\/jats:sup>\n 3<\/jats:sub>\n \u2009=\u20098.4; interaction\n P<\/jats:italic>\n \u2009=\u2009.04), starting at values above 30 mm\n 2<\/jats:sup>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this 25-year follow-up cohort study, increasing ERO was associated with an increase in risk of mortality under medical therapy. Patients with upper-moderate MR (ERO 30-39 mm\n 2<\/jats:sup>\n ) at baseline demonstrated a significant association between surgical treatment and improved long-term survival.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.2389","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:30:36Z","timestamp":1785339036000},"page":"832","source":"Crossref","is-referenced-by-count":3,"title":["Twenty-Five\u2013Year Follow-Up of Quantified Mitral Regurgitation"],"prefix":"10.1001","volume":"11","author":[{"given":"Anastasiia","family":"Karadzha","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartzell V.","family":"Schaff","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Lahr","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vuyisile T.","family":"Nkomo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behrooz","family":"Banivaheb","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Enriquez-Sarano","sequence":"additional","affiliation":[{"name":"The Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9","key":"hoi260034r1","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1056\/NEJMoa041451","article-title":"Quantitative determinants of the outcome of asymptomatic mitral regurgitation.","volume":"352","author":"Enriquez-Sarano","year":"2005","journal-title":"N Engl J Med"},{"issue":"4","key":"hoi260034r2","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1016\/j.jacc.2020.11.018","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"77","author":"Otto","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"22","key":"hoi260034r3","doi-asserted-by":"publisher","first-page":"2398","DOI":"10.1016\/j.jacc.2014.02.577","article-title":"Early surgery versus conventional treatment for 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