Ma JI, et al. - In 82 asymptomatic mitral valve prolapse (MVP) patients (65 ± 12 years, 51% men) with mild or moderate mitral regurgitation (MR: 36 mild, 46 moderate, mean LVEF: 62%), with no significant co-morbidities, researchers investigated if abnormalities of cardiac structure and function could predict progression in MR severity. They analyzed clinical findings and 13 echo measurements. Over a mean follow-up period of 4.5 ± 2.7 years, patients with mild and moderate MR had similar mortality and heart failure development. Progression to severe MR was evident in 50% of asymptomatic MVP patients with moderate MR, but in none with mild MR progressed to severe MR. Progression of moderate to severe MR was predicted only by the mitral annular dimension. With area under the curve 0.78, sensitivity 100%, and specificity 63.8%, values > 39.6 mm predicted progression accurately. Findings were suggestive of a possible utility of mitral annulus diameter in identifying asymptomatic MVP patients at risk of developing severe MR.