OBJECTIVES: The objective of the present study was to use cardiovascular magnetic resonance (CMR) to examine the natural history of secondary MR severity and the implication of left ventricular (LV) scar on its prognostic significance.

BACKGROUND: There is a need for further understanding of the prognostic implication of secondary mitral regurgitation (MR) given the heterogeneous findings of the 2 recent randomized trials on percutaneous mitral intervention in patients with secondary MR.

METHODS: Patients with heart failure were enrolled into a prospective observational registry between 2008 and 2019. Outcomes were a composite of all-cause death, heart transplantation, or LV assist device implantation at follow-up. CMR was used to quantify the mitral regurgitation volume and mitral regurgitation fraction (MRF) along with scar burden utilizing late gadolinium enhancement. Patients were categorized into 4 subgroups based on presence and tertiles of scar extent: no scar, limited scar (scar burden 1% to 4%), intermediate scar (scar burden 5% to 20%), and extensive scar (scar burden >20%).

RESULTS: Among patients (n = 441) included in the study (age 59 ± 14 years, 43% with ischemic etiology), 85 (19%) experienced an adverse event. MRF ≥30% was associated with increased risk of events among the study group (hazard ratio: 1.74; 95% confidence interval: 1.10 to 2.76; p = 0.02). When stratified by presence or absence of scar, MRF ≥30% was associated with events only among patients with scar (hazard ratio: 1.67; 95% confidence interval: 1.02 to 2.76; p = 0.04) but not among patients without scar. On further classification of patients with scar, the prognostic significance of secondary MR was observed primarily among patients with intermediate scar burden.

CONCLUSIONS: The natural history of secondary MR is complex, and outcomes are affected by severity of MR and vary depending upon the extent of scar. (DeBakey Cardiovascular Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823).

Original languageEnglish (US)
Pages (from-to)812-822
Number of pages11
JournalJACC: Cardiovascular Imaging
Issue number4
StatePublished - Apr 2021


  • cardiovascular magnetic resonance
  • late gadolinium enhancement
  • myocardial scar
  • secondary mitral regurgitation
  • Mitral Valve Insufficiency/diagnostic imaging
  • Predictive Value of Tests
  • Heart Failure/diagnostic imaging
  • Prognosis
  • Prospective Studies
  • Cicatrix/diagnostic imaging
  • Humans
  • Middle Aged
  • Gadolinium
  • Contrast Media
  • Aged

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Impact of Myocardial Scar on Prognostic Implication of Secondary Mitral Regurgitation in Heart Failure'. Together they form a unique fingerprint.

Cite this