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Accurate grading of aortic regurgitation (AR) severity is crucial for treatment decisions. This study aimed to determine whether phase contrast cardiac magnetic resonance (PC-CMR) in the descending aorta can be used as a supporting reference for grading of the AR severity in patients with chronic AR. PC-CMR was performed both in the ascending and descending aorta of 191 AR-patients. Regurgitation thresholds in the descending aorta for hemodynamically significant AR [regurgitation volume (RVol) DA and fraction (RF) DA ] were determined in 41 well-controlled patients and then validated in a cohort surveyed for AR in our clinic. Myerson’s outcome-based thresholds (RVol > 42 mL, RF > 33%) served as reference. For comparison, holodiastolic flow reversal (HFR) was determined. Regurgitation measurements in the descending and ascending aorta were strongly correlated (RVol: R  ≥ 0.92; RF: R  ≥ 0.85; p  < 0.001). Diagnostic performance of RVol DA >17 mL and RF DA >23% was high (sensitivity: 92%, 83%; specificity: 95%, 93%) and more patients with significant AR were identified using these PC-MRI based thresholds [RVol DA >17mL (13%) and RF DA >23% (15%)] than with HFR alone. PC-CMR in the descending aorta has the potential to reliably grade AR severity in patients with chronic AR and thereby may serve as a supportive reference in the decision-making regarding optimal timing of intervention.

In the era of mitral transcatheter edge-to-edge repair (M-TEER), growing evidence continues to support a shift from a binary classification of mitral regurgitation (MR) into primary and secondary forms toward a more refined, subtype-based approach. Additionally, anatomical and pathophysiological heterogeneity significantly influences procedural complexity, durability of repair, and clinical outcomes within both primary and secondary MR. Furthermore, recent trials suggest that the timing of the intervention is as critical as patient anatomy; delaying treatment until advanced ventricular remodeling has occurred may limit the benefits of MR reduction. Moreover, long-term data on durability and device-failure management remain limited, particularly in secondary MR, where the progression of the underlying cardiomyopathy largely determines the outcomes. Thus, this review underscores how integrating MR subtyping with intervention strategies may influence patient selection and highlights the need for future research to adopt a more individualized, mechanism-driven approach.

Atrial secondary tricuspid regurgitation (A-STR) and ventricular secondary tricuspid regurgitation (V-STR) have unique physiological and anatomical differences, but long-term outcomes based on TR etiology remain poorly understood. This study aimed to assess the characteristics and outcomes of severe A-STR and V-STR. Adults diagnosed with severe secondary TR between January 2017 and December 2019 in a quaternary-care health system were included. TR was classified into left-sided V-STR (left-sided cardiac diseases), right-sided V-STR (pulmonary/vascular diseases), and A-STR (atrial pathology). The primary endpoint was to assess survival at follow-up. Incidence of heart failure (HF) hospitalizations and cardiovascular mortality were secondary endpoints. Among 1,037 patients with STR, 125 (12.0%) had A-STR, 737 (71.1%) left-sided V-STR, and 175 (16.9%) right-sided V-STR. Survival was significantly higher for A-STR compared to left and right-sided V-STR (46.9% vs 30.6% vs 22.0%, log-rank p = 0.042, respectively). At multivariable Cox regression analysis, left and right-sided V-STR were independently associated with worse survival compared to A-STR (HR: 1.439, p = 0.039 and HR: 1.816, p = 0.001, respectively). A-STR patients also experienced lower rates of HF hospitalizations and cardiovascular mortality. A-STR was associated with better survival and fewer HF hospitalizations than V-STR groups, with right-sided V-STR being the strongest independent predictor of all-cause mortality.

The population-based studies on the epidemiologic features of valvular regurgitation in Northeast China are scarce. We aim to estimate the prevalence and risk factors of mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR) in a general population from rural Northeast China. Valvular regurgitation was assessed by color flow Doppler echocardiography in a population-based survey of 11,278 participants aged ≥35 years in rural areas of Liaoning Province during 2012 to 2013. The prevalence of mild or greater MR and TR were 1.6% and 1.5%, respectively. Trace or greater AR was present in 4.1% of the participants. In the multivariable regression model, older age, left atrial dimension, low left ventricular (LV) ejection fraction, and fasting plasma glucose were associated with higher risk of MR in men, whereas only older age and left atrial dimension increased the risk in women. Body mass index was found to be a protective factor for MR in women (odds ratio 0.847, 95% confidence interval 0.741 to 0.969). TR was independently associated with age, heart rate, low LV ejection fraction, current drinking status, and high-density lipoprotein cholesterol. The risk for AR significantly increased with age in both genders. LV mass index and aortic dimension increased the risk of AR in males, and females with higher LV mass index and high-density lipoprotein cholesterol had an increased risk for AR. In both genders, systolic blood pressure presented as a risk factor for AR, while diastolic blood pressure as a protective factor. In this large Chinese population-based study, we found remarkably low prevalence of valvular regurgitation, adding evidence for estimating disease burden and making policy strategies in Northeast China.

[...]predilatation was done in 325 (88%) of 372 patients treated with ACURATE neo versus 83 (23%) of 367 patients with SAPIEN 3 (p<0·0001).1 We compared the frequency of moderate or severe aortic regurgitation stratified by predilatation status and valve type appendix. [...]it is more likely that the observed differences in paravalvular regurgitation might be overcome by device iterations, such as those introduced in the ACURATE neo 2 valve. SW's institution has received research and educational grants from Abbott, Amgen, Bristol-Myers Squibb, Bayer, Boston Scientific, Biotronik, Cardinal Health, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Johnson and Johnson, Medtronic, Polares, Querbet, Sanofi, Sinomed, and Terumo.

Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.

Development of functional tricuspid regurgitation (TR) because of chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes after transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR. This was a single-center, retrospective analysis of patients who received valve-in-valve or valve-in-ring TMVR between 2012 and 2022. Patients were categorized into none/mild TR and moderate/severe TR based on baseline echocardiography. The primary outcome was 3 years all-cause death and the secondary outcomes were in-hospital events. Of the 135 patients who underwent TMVR, 64 (47%) exhibited none/mild TR at baseline, whereas 71 (53%) demonstrated moderate/severe TR. There were no significant differences in in-hospital events between the groups. At 3 years, the moderate/severe TR group exhibited a significantly increased risk of all-cause death (adjusted hazard ratio 3.37, 95% confidence interval 1.35 to 8.41, p = 0.009). When patients with baseline moderate/severe TR were stratified by echocardiography at 30 days into improved (36%) and nonimproved (64%) TR groups, although limited by small sample size, there was no significant difference in 3-year all-cause mortality (p = 0.48). In conclusion, this study investigating the impact of baseline TR on clinical outcomes revealed that moderate/severe TR is prevalent in those who underwent TMVR and is an independent predictor of 3-year all-cause mortality. Earlier mitral valve intervention before the development of significant TR may play a pivotal role in improving outcomes after TMVR.

Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.

ObjectiveTransitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking.MethodsWe used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed.ResultsIn the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%).ConclusionsClinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.