DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.059

Pages: 1580-1583

Background: Mitral regurgitation (MR) is a common and prognostically important complication of heart failure. Echocardiography is the gold standard for its assessment, yet data on its independent prognostic impact in real-world cohorts remain limited. Methods: We conducted a retrospective, observational, single-center study including 170 patients with heart failure (HFrEF or HFpEF) and at least moderate MR. All patients underwent complete transthoracic echocardiography with quantification of MR using vena contracta width (VCW), effective regurgitant orifice area (EROA), and regurgitant volume (RVol). Patients were followed for a median of 30 months. The primary endpoint was all-cause mortality. Results: Mean age was 68 +/- 11 years; 68% were male. Severe MR was present in 65 patients (38%). Compared to moderate MR, severe MR was associated with larger indexed left atrial volumes (LAVi 58 +/- 12 vs 42 +/- 10 mL/m2, p<0.001), lower ejection fraction (32 +/- 8% vs 41 +/- 9%, p<0.001), and higher estimated pulmonary artery pressures (52 +/- 11 vs 43 +/- 9 mmHg, p<0.001). In multivariate Cox regression analysis, severe MR (HR 2.1; 95% CI 1.4-3.2; p<0.001) and LAVi >48 mL/m2 (HR 1.8; 95% CI 1.2-2.7; p=0.004) were independent predictors of mortality. Conclusions: Severe MR and left atrial dilation are independent and powerful prognostic markers in heart failure, identifying a very high-risk subgroup. Echocardiographic quantification of MR should integrate proportionality assessment, left atrial remodeling, and global longitudinal strain to guide optimal therapeutic strategies, including percutaneous repair.