Mitral regurgitation stages
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Twinkle Singh, M.B.B.S. [2]
Overview
Stages of Primary Mitral Regurgitation
Shown below is the able depicting stages of mitral regurgitation, adapted from 2014 AHA/ACC guidelines for management of valvular heart disease.[1]
MR: Mitral regurgitation; MVP: Mitral valve prolapse; IE: Infective endocarditis; LA: Left atrium; ERO: Effective regurgitant orifice; LV: Left ventricle; LVEF: Left ventricular ejection fraction; LVESD: Left ventricular end systolic dimension
| STAGE | DEFINITION | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
|---|---|---|---|---|---|
| A | At risk of MR | ❑ Mild MVP, normal coaptation ❑ Mild valve thickening and leaflet restriction |
❑ No MR jet area or central jet area < 20% LA on doppler ❑ Small vena contracta <0.3 cm |
Absent | Absent |
| B | Progressive MR | ❑ Severe MVP, normal coaptation ❑ Rheumatic valve changes with leaflet restriction and loss of central coaptation due to ❑ Previous infective endocarditis |
❑ Central jet area 20-40% LA or late systolic eccentric jet MR ❑ Vena contracta < 0.7 cm ❑ Regurgitant volume < 60 ml ❑ Regurgitant fraction <50 % ❑ ERO <0.40 cm2 ❑ Angiographic grade 1 - 2+ |
❑ Mild LA enlargement ❑ Absent LV enlargement ❑ Normal pulmonary pressure |
Absent |
| C | Asymptomatic severe MR | ❑ Severe MVP, flail leaflet ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Prior IE ❑ Thickening of leaflets in case of radiation heart disease |
❑ Central jet area > 40% LA OR holosystolic eccentric jet MR ❑ Vena contracta ≥ 0.7 cm ❑ Regurgitant volume ≥ 60 ml ❑ Regurgitant fraction ≥50 % ❑ ERO ≥0.40 cm2 ❑ Angiographic grade 3 - 4+ |
❑ Moderate to severe LA enlargement ❑ LV enlargement ❑Pulmonary hypertension present at rest or with exercise ❑ C1: LVEF > 60% and LVESD < 40 mm ❑ C2: LVEF ≤ 60 % and LVESD ≥ 40 mm |
Absent |
| D | Symptomatic severe MR | ❑ Severe MVP, flail leaflet ❑ Rheumatic valve changes with leaflet restriction, loss of central coaptation ❑ Previous infective endocarditis ❑ Thickening of leaflets in case of radiation heart disease |
❑ Central jet area >40% LA OR holosystolic eccentric jet MR ❑ Vena contracta ≥ 0.7 cm ❑ Regurgitant volume ≥ 60 ml ❑ Regurgitant fraction ≥ 50 % ❑ ERO ≥0.40 cm2 ❑ Angiographic grade 3 - 4+ |
❑ Moderate to severe LA enlargement ❑ LV enlargement ❑ Pulmonary hypertension present |
❑ Decreased exercise tolerance ❑ Exertional dyspnea |
Stages of Secondary Mitral Regurgitation
References
- ↑ Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.