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Revisiting and Confirming the Prognostic Importance of Effective Regurgitant Orifice Area in Degenerative Mitral Regurgitation

It has been 13 years since Enriquez-Sarano et al 1 reported the prognostic importance of effective regurgitant orifice area (EROA) and, to a lesser degree, regurgitant volume (RV) in asymptomatic “organic” mitral regurgitation (MR), thus emphasizing the importance of quantitative echo-Doppler assessment to determining MR severity. The study highlighted the proximal isovelocity surface area (PISA) and quantitative Doppler approaches, with recognition of caveats to the PISA approach in patients with mitral prolapse, which has been previously noted by their group.2,3 In this issue of Circulation, Antoine et al4 revisit these concepts, again demonstrating the relation between EROA and RV with survival and making a compelling argument for calculating EROA and RV as components of the echocardiographic assessment of MR severity.