Patients with both aortic and mitral regurgitation face substantially higher risks of adverse cardiac remodeling and death compared with those with isolated aortic regurgitation. A multicenter study published in JACC: Cardiovascular Imaging used CMR to quantify these differences, offering new insight into how combined valve disease influences long-term outcomes.

The study analyzed 915 patients with moderate or severe aortic regurgitation (median age 61 years), 79.5% of whom were men. Among them, 27% also had mitral regurgitation with a median MR fraction of 24%. Patients with concomitant moderate or greater MR demonstrated greater left ventricular enlargement per unit increase in AR severity and reduced systolic function.

Over a median follow-up of three years, 152 deaths occurred. Combined AR and MR increased the hazard for all-cause mortality (HR 2.77; 95% CI 1.91–4.01; P < 0.001) and for the composite outcome of death or HF hospitalization (HR 2.62; 95% CI 1.87–3.67; P < 0.001). Even asymptomatic or minimally symptomatic patients under medical surveillance exhibited elevated mortality and HF risk, independent of age, sex, ejection fraction, and comorbidities.

These findings call for closer follow-up and timely intervention in patients with moderate combined AR and MR, as current management relies mainly on expert opinion.