Anatomical analysis and prognostic assessment of degenerative mitral regurgitation based on a large echocardiography database: Implications for transcatheter edge-to-edge and chordal repair

Background and Objectives: The anatomical characteristics of patients with mitral valve prolapse (MVP) and mitral regurgitation (MR) have rarely been investigated demographically to determine the applicability of transcatheter intervention. Therefore, the study objective was to analyze potential candidates and their prognosis. Predictors determining the prognosis were also investigated. Methods: Patients diagnosed with MVP and MR severity of ≥2+ were screened from our echocardiography database from 2010 to 2012. All clinical and echocardiogram information was retrieved from electronic medical records. The endpoint was all-cause mortality analyzed by a proportional hazards model. Results: A total of 1268 patients (mean age 57.50 ± 14.88 years, 47.16% female) with MVP and MR severity of ≥ 2+ were included. Isolated P2 (n = 239, 18.85%) appeared as the most common site of leaflet prolapse. The incidence of MR jet solely from middle scallop (A2 and/or P2) was 31.07% (n = 394). If a nonsignificant jet from other locations was also accepted, the incidence of MR jet derived from mainly the middle scallop (A2 and/or P2) was 52.10% (n = 659). For MVP patients with MR R + 3, the conservative therapy group had higher mortality than the early surgery group (31.45% vs. 5.25%, P < 0.001) after 4.5 ± 1.0 years of follow-up, multiple analysis showed that surgical treatment (hazard ratio [HR]: 0.202, P < 0.001), systolic pulmonary artery pressure of o60 mmHg (HR: 6.816, P < 0.001), age of ≥ 60 years (HR: 3.838, P < 0.001), and pericardial effusion (HR: 1.915, P = 0.003) were independent predictors of all-cause mortality. Conclusions: In patients with MVP, one-fifth leaflet prolapse located solely in P2 and one-half of MR jet derived from the middle scallop were anatomically eligible for transcatheter chordal repair and edge-to-edge repair therapy, respectively. Initial conservative therapy, pericardial effusion, pulmonary hypertension, and advanced age were independent predictors of a higher mortality rate in MVP patients with MR severity of ≥ 3+.