Prognostic impact of regurgitant volume to left atrial volume ratio on ventricular functional mitral regurgitation

European Heart Journal - Cardiovascular Imaging

6 November 2025
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ESC Journals HEART FAILURE Acute Heart Failure Chronic Heart Failure IMAGING Echocardiography Interventional Cardiology VALVULAR, MYOCARDIAL, PERICARDIAL, PULMONARY, CONGENITAL HEART DISEASE Valvular Heart Disease

Abstract

AbstractAims

In patients with ventricular functional mitral regurgitation (VFMR) undergoing transcatheter edge-to-edge repair (M-TEER), the prognostic significance of the ratio between mitral regurgitant volume and left atrial volume (LAV) remains unclear. This ratio may reflect the proportional or disproportionate burden of regurgitation on the left atrium. To address this gap, we aimed to investigate the association between the regurgitant volume (RVol)/LAV ratio and clinical outcomes in patients with VFMR, using data from a multicentre prospective registry.

Methods and results

We calculated the RVol/LAV ratio from baseline transthoracic echocardiograms. The median value of the RVol/LAV ratio was 0.40. A total of 1830 patients who underwent M-TEER were allocated into two groups: the low RVol/LAV (RVol/LAV ratio <0.40) and high RVol/LAV (RVol/LAV ratio ≥0.40) groups. The primary endpoint was heart failure hospitalization. Eight hundred eighty-eight and 942 patients were included into the low RVol/LAV ratio and high RVol/LAV ratio groups, respectively. The median follow-up period was 508 days. At 3 years after repair, 215 (37.6%) and 187 (32.1%) patients in the low RVol/LAV and high RVol/LAV groups, respectively, were hospitalized for heart failure. The patients in the low RVol/LAV group demonstrated a significantly higher risk of heart failure hospitalization than did those in the high RVol/LAV group (hazards ratio, 1.25; 95% confidence interval, 1.03–1.52; P = 0.022). Furthermore, using multivariable Cox regression analysis, the low RVol/LAV was an independent predictor of the primary endpoint.

Conclusion

The RVol/LAV ratio might serve as a valuable metric for improving risk stratification in patients with VFMR.

Clinical trials

OCEAN Mitral registry (UMIN ID: UMIN000023653)

Contributors

Hisao Otsuki
Hisao Otsuki

Author

Stanford University Stanford , United States of America

Mike Saji
Mike Saji

Author

Toho University Omori Medical Center Tokyo , Japan

Masahiko Asami
Masahiko Asami

Author

Mitsui Memorial Hospital Tokyo , Japan

Kentaro Hayashida
Kentaro Hayashida

Author

Kansai Medical University Osaka , Japan

Yun Teng
Yun Teng

Author

Yu Sato
Yu Sato

Author

Ryo Abe
Ryo Abe

Author

Ryo Abe
Ryo Abe

Author

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