The Mitral-Regurgitation-International-Database (MIDA) score is a validated tool for Degenerative-Mitral-Regurgitation (DMR) management. However, whether this score complemented with DMR quantitation is applicable and incremental over the entire span of Floppy Mitral Valves (FMV), and DMR severity remains unsubstantiated.

The MIDA-Quantitative (MIDA-Q) unprecedented registries include 8187 consecutive patients (age 64±17 years, 45% women, follow-up 5.5±3.4 years) with isolated FMV diagnosed at tertiary (European/North-American/Middle East) centers in which DMR quantitative grading was consistently and prospectively performed. The MIDA-Q Score ranged from 0 to 15 depending on accumulating risk factors. Long-term survival overall, under medical management and post-mitral surgery was analyzed.

By quantitative grading, MR was no/trivial in 1938 (24%), mild in 1423 (17%), moderate in 2027 (25%) and severe in 2799 (34%), with ERO 0.24±24cm², RVol 37±35mL and with posterior leaflet prolapse in 49%. MIDA-Q Scores stratified in 8 categories were 0 (score 0, n=851), 1 (score 1–2, n=1301), 2 (score 3–4, n=2043), 3 (score 5–6, n=1581), 4 (score 7–8, n=1273), 5 (score 9–10, n=718), 6 (score 11–12, n=331) and 7 (score 13–15, n=89). In the whole MIDA-Q population (n=8187 patients), 5-year survival under medical management with Scores categories 0-1, 2–4, and 5–7 was 96±1%, 73±1%, and 61±3% respectively (P<0.0001). After mitral surgery, 1-year mortality with Scores categories 0–1, 2–4, and 5–7 was 0%, 1%, and 6% respectively and 5-year post-operative survival was 99±1%, 94±1%, and 82±2% (all P<0.0001). In nested models including age, sex and EuroScoreII, the MIDA Score was incrementally, and the MIDA-Q Score further incrementally prognostic for long-term survival (P<0.001) (Figure 1).

This very large international cohort demonstrates the strong, independent and incremental predictive power of the MIDA-Q Score for survival after diagnosis of FMV.