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American Heart Association

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Final ID: 4366354

Unmasking Risk: Clinical Outcomes of Moderate Aortic Stenosis with Concomitant Mitral Regurgitation—A Cardiac MRI-Based Evaluation

Abstract Body (Do not enter title and authors here): Objective: The clinical trajectory of patients with moderate aortic stenosis (AS) complicated by concomitant mitral regurgitation (MR) remains poorly defined. While management strategies in severe AS are well established, patients with moderate AS and MR often fall below guideline-based thresholds for intervention despite symptoms and remodeling. We used cardiac magnetic resonance (CMR)—a robust modality for accurate valve quantification, particularly in mixed valvular disease— to assess the prognostic impact of MR in moderate AS and to compare the outcomes to patients with severe AS.

Methods: We analyzed consecutive patients from the DeBakey CMR Registry (2008–2023) with ≥moderate AS on clinically indicated CMR. Exclusions included >mild aortic regurgitation or mitral stenosis, subaortic obstruction, infiltrative cardiomyopathies, pre-capillary pulmonary hypertension, advanced malignancy, or unavailable follow-up. Patients were stratified by AS severity (moderate vs. severe) and MR grade (
Results: In a multivariate Cox regression analysis of 422 patients with moderate AS, both mitral regurgitant (MR) fraction on CMR (hazard ratio [HR] per 5% increase: 1.10; 95% CI: 1.04–1.16; P < 0.001) and the presence of ≥ moderate MR (HR: 1.86; 95% CI: 1.31–2.65; P < 0.001) were independently associated with the composite outcome (Table 1). In moderate AS, penalized spline regression analysis showed a statistically significant increase in risk with increasing MR fraction (P<0.001 for linearity; P=0.028 for non-linearity; Figure 1). Kaplan-Meier curves demonstrated poorer 3-year event-free survival in patients with moderate AS and concomitant ≥moderate MR (33%) compared with both isolated severe AS (71%) and severe AS with ≥moderate MR (49%) (Figure 2).

Conclusion: In moderate AS, concomitant MR is an independent predictor of adverse clinical composite outcomes. Patients with moderate AS and ≥moderate MR had worse composite outcomes than those with isolated severe AS, underscoring the additive risk of dual-valve pathology. These findings support more vigilant monitoring and may justify re-evaluation of treatment thresholds in this mixed valvular disease subgroup.
  • Gabr, El-moatasem  ( Houston Methodist Hospital , Cleveland , Ohio , United States )
  • Xiao, Mianli  ( Houston Methodist , Houston , Texas , United States )
  • Saeed, Mujtaba  ( Albert Einstein College of Medicine , Bronx , New York , United States )
  • Darwish, Amr  ( Cleveland Clinic , Cleveland , Ohio , United States )
  • Bersali, Akila  ( Houston Methodist Hospital , Cleveland , Ohio , United States )
  • Dhore, Aneesh  ( Houston Methodist Hospital , Cleveland , Ohio , United States )
  • Graviss, Edward  ( Houston Methodist Hospital , Houston , Texas , United States )
  • Malahfji, Maan  ( Houston Methodist Hospital , Houston , Texas , United States )
  • Shah, Dipan  ( HOUSTON METHODIST HOSPITAL , Houston , Texas , United States )
  • Author Disclosures:
    El-Moatasem Gabr: DO NOT have relevant financial relationships | Mianli Xiao: DO NOT have relevant financial relationships | Mujtaba Saeed: DO NOT have relevant financial relationships | Amr Darwish: DO NOT have relevant financial relationships | Akila Bersali: No Answer | Aneesh Dhore: No Answer | Edward Graviss: No Answer | Maan Malahfji: DO NOT have relevant financial relationships | Dipan Shah: DO NOT have relevant financial relationships
Meeting Info:

Scientific Sessions 2025

2025

New Orleans, Louisiana

Session Info:

Melvin Judkins Early Career Clinical Investigator Award Competition

Saturday, 11/08/2025 , 09:45AM - 11:00AM

Abstract Oral Session

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