A New Scoring System for Predicting the Risk for Mitral Regurgitation and Its Severity in Patients with Mitral Valve Prolapse

Background: Due to the possibility of occurrence and exacerbation of mitral regurgitation (MR) in the context of mitral valve prolapse (MVP) in a significant portion of patients, early and non-invasive prediction of this complication based on clinical and echocardiographic parameters is important and vital. This prediction can essentially be based on the provision of efficient grading systems. Objectives: We aimed to achieve this goal by identifying factors predicting the exacerbation of MR and classifying them in the form of a new scoring system. Methods: One hundred and five patients with suspected MVP were included in this cross-sectional study and assessed by echocardiography. The patients underwent echocardiography, and the severity of the MR, as well as structural changes of valves due to prolapse (leaflets and scallops involvements), was determined. Results: In a multivariable logistic regression model, age > 40 years, posterior mitral valve leaflet (PMVL) involvement, and P2 or A2P2 scallop involvement were identified as the main risk determinants for moderate to severe MR. These factors were structured as a new scoring system (scaled 3 to 10), where a total risk score of less than 6, between 6 to 8, and higher than 8 was considered low, moderate, and high risk for moderate to severe MR, respectively. Conclusions: The scoring system provided for predicting the exacerbation of mitral insufficiency in patients with a prolapsed valve can potentially guide early intervention.