BACKGROUND:Mitral valve prolapse (MVP) is responsible for a considerable disease burden but is widely heterogeneous. The lack of a comprehensive prognostic instrument covering the entire MVP spectrum, encompassing the quantified consequent degenerative mitral regurgitation (DMR), hinders clinical management and therapeutic trials.METHODS:The new Mitral Regurgitation International Database Quantitative (MIDA-Q) registry enrolled 8187 consecutive patients (ages 63±16 years, 47% women, follow-up 5.5±3.3 years) first diagnosed with isolated MVP, without or with DMR quantified prospectively (measuring effective regurgitant orifice [ERO] and regurgitant volume) in routine practice of 5 tertiary care centers from North America, Europe, and the Middle East. The MIDA-Q score ranges from 0 to 15 by accumulating guideline-based risk factors and DMR severity. Long-term survival under medical management was the primary outcome end point.RESULTS:MVP was associated with DMR absent/mild (ERO <20 mm²) in 50%, moderate (ERO 20–40 mm²) in 25%, and severe or higher (ERO ≥40 mm²) in 25%, with mean ERO 24±24 mm², regurgitant volume 37±35 mL. Median MIDA-Q score was 4 with a wide distribution (10%–90%; range, 0–9). MIDA-Q score was higher in patients with EuroScore II ≥1% versus <1% (median, 7 versus 3; P < 0.0001) but with wide overlap (10%–90%; range, 4–11 versus 0–7) and mediocre correlation (R² 0.18). Five-year survival under medical management was strongly associated with MIDA-Q score, 97±1% with score 0, 95±1% with score 1 to 2, 82±1% with score 3 to 4, 67±1% with score 5 to 6, 60±1% with score 7 to 8, 44±1% with score 9 to 10, 35±1% with score 11 to 12, and 5±4% with MIDA-Q score ≥13, with hazard ratio 1.31 [1.29–1.33] per 1-point increment. Excess mortality with higher MIDA-Q scores persisted after adjustment for age, sex, and EuroScore II (adjusted hazard ratio, 1.13 [1.11–1.15] per 1-point increment). Subgroup analysis showed persistent association of MIDA-Q score with mortality in all possible subsets, in particular, with EuroScore II<1% (hazard ratio, 1.08 [1.02–1.14]) or ≥1% (hazard ratio, 1.11 [1.08–1.13]) and with no/mild DMR (hazard ratio, 1.14 [1.10–1.19]) or moderate/severe DMR (hazard ratio, 1.13 [1.10–1.16], all per 1-point increment with P<0.0001). Nested-model and bootstrapping analyses demonstrated incremental prognostic power of MIDA-Q score (all P<0.0001).CONCLUSION:This large, international cohort of isolated MVP, with prospective DMR quantification in routine practice, demonstrates the wide range of risk factor accumulation and considerable heterogeneity of outcomes after MVP diagnosis. The MIDA-Q score is strongly, independently, and incrementally associated with long-term survival after MVP diagnosis, irrespective of presentation, and is therefore a crucial prognostic instrument for risk stratification, clinical trials, and management of patients diagnosed with all forms of MVP.

中文翻译：

---

MIDA-Q 死亡风险评分：二尖瓣脱垂谱的定量预后工具

背景：二尖瓣脱垂（MVP）造成相当大的疾病负担，但具有广泛的异质性。缺乏覆盖整个 MVP 谱系（包括量化的继发性退行性二尖瓣反流 (DMR)）的综合预后工具，阻碍了临床管理和治疗试验。 方法：新的二尖瓣反流国际定量数据库 (MIDA-Q) 登记注册了 8187 名连续患者（年龄 63±16 岁，47% 女性，随访 5.5±3.3 年）首次诊断为孤立性 MVP，在 5 个三级护理的常规实践中，在没有或有 DMR 的情况下进行前瞻性量化（测量有效反流口 [ERO] 和反流量）来自北美、欧洲和中东的中心。MIDA-Q 评分范围为 0 至 15，通过累积基于指南的风险因素和 DMR 严重程度。医疗管理下的长期生存是主要结局终点。 结果：MVP 与50% 的DMR 缺失/轻度 (ERO <20 mm ^{2 )、25% 的中度 (ERO 20–40 mm 2} ) 和重度 DMR相关。 25%或更高（ERO ≥40 mm ²），平均ERO 24±24 mm ²，反流量37±35 mL。MIDA-Q 得分中位数为 4，分布广泛（10%–90%；范围为 0–9）。EuroScore II ≥1% 与 <1% 的患者的 MIDA-Q 评分较高（中位数为 7 与 3；P < 0.0001），但重叠范围较广（10%–90%；范围为 4-11 与 0-7）相关性一般 ( R ² 0.18)。医疗管理下的五年生存率与 MIDA-Q 评分密切相关，评分为 0 时为 97±1%，评分为 1 至 2 时为 95±1%，评分为 3 至 4 时为 82±1%，评分为 67±1% 5 至 6 分、7 至 8 分为 60±1%、9 至 10 分为 44±1%、11 至 12 分为 35±1%、MIDA-Q 分数≥13 为 5±4%，具有风险比每 1 点增量 1.31 [1.29–1.33]。在调整年龄、性别和 EuroScore II 后，较高 MIDA-Q 分数的超额死亡率仍然存在（调整后的风险比，每 1 分增量 1.13 [1.11–1.15]）。亚组分析显示，MIDA-Q 评分与所有可能亚组中的死亡率持续相关，特别是 EuroScore II <1%（风险比，1.08 [1.02–1.14]）或 ≥1%（风险比，1.11 [1.08–1.13]） ]）以及无/轻度 DMR（风险比，1.14 [1.10–1.19]）或中度/重度 DMR（风险比，1.13 [1.10–1.16]，所有每 1 点增量，P <0.0001 ）。嵌套模型和引导分析证明了 MIDA-Q 评分的增量预后能力（所有P<0.0001）。结论：这一大型国际孤立 MVP 队列在常规实践中进行了前瞻性 DMR 量化，证明了 MVP 诊断后危险因素积累的范围广泛以及结果的相当大的异质性。无论表现如何，MIDA-Q 评分与 MVP 诊断后的长期生存密切、独立且递增地相关，因此是风险分层、临床试验和诊断为各种形式 MVP 的患者管理的重要预后工具。