Impact of Concomitant Mitral Regurgitation in Moderate Aortic Stenosis

BACKGROUND: Patients with moderate aortic stenosis (AS) and concomitant mitral regurgitation (MR) often present with symptoms despite neither lesion individually reaching intervention thresholds. The clinical impact of this dual valvular disease remains a knowledge gap. OBJECTIVES: The aims of this study were to evaluate the effect of concomitant MR on cardiac remodeling and clinical outcomes in patients with moderate AS using cardiac magnetic resonance (CMR) and to compare with isolated moderate and severe AS. METHODS: A total of 742 patients with at least moderate AS on CMR (422 with moderate AS, 320 with severe AS) were studied. Patients were stratified by AS severity and MR burden. Remodeling parameters, symptoms, and outcomes, including cardiovascular death and heart failure hospitalization, were analyzed. Multivariable Cox models identified covariates associated with outcomes. RESULTS: ), whereas in normal-flow patients, there was a trend toward increased risk that did not reach statistical significance. Outcomes in moderate AS with moderate or greater MR were worse than in isolated severe AS and comparable with severe AS populations meeting criteria for intervention. CONCLUSIONS: ). CMR enables the quantitative assessment of dual valvular burden and may improve risk stratification. These findings highlight a therapeutic gap and support studies of earlier intervention in this high-risk subgroup.