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Heart (British Cardiac Society) May 2020Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and... (Review)
Review
Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.
Topics: Cardiomyopathies; Heart Failure; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Prognosis; Treatment Outcome; Ventricular Remodeling
PubMed: 32054671
DOI: 10.1136/heartjnl-2019-316238 -
The Journal of Thoracic and... Mar 2024
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Heart Valve Prosthesis Implantation; Catheters; Mitral Valve Annuloplasty
PubMed: 36109209
DOI: 10.1016/j.jtcvs.2022.07.034 -
Hellenic Journal of Cardiology : HJC =... 2021
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Stenosis
PubMed: 33771729
DOI: 10.1016/j.hjc.2021.03.002 -
Journal of Cardiothoracic and Vascular... May 2023
Topics: Humans; Mitral Valve; Mitral Valve Insufficiency; Echocardiography; Catheters
PubMed: 36792461
DOI: 10.1053/j.jvca.2023.01.020 -
JACC. Cardiovascular Interventions Oct 2021
Topics: Heart Valve Prosthesis; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 34600872
DOI: 10.1016/j.jcin.2021.08.040 -
The Journal of Thoracic and... Jul 2021
Topics: Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency
PubMed: 32111426
DOI: 10.1016/j.jtcvs.2020.02.001 -
Catheterization and Cardiovascular... Feb 2021
Topics: Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 33587799
DOI: 10.1002/ccd.29494 -
Heart Failure Clinics Jul 2023The causes of mitral regurgitation (MR) can be broadly divided into primary and secondary causes. Although primary MR is caused by degenerative alterations of the mitral... (Review)
Review
The causes of mitral regurgitation (MR) can be broadly divided into primary and secondary causes. Although primary MR is caused by degenerative alterations of the mitral valve and the mitral valve apparatus, secondary (functional) MR is multifactorial and related to dilation of the left ventricle and/or mitral annulus commonly resulting in concomitant restriction of the leaflets. Therefore, the treatment of secondary MR (SMR) is complex and includes guideline directed heart failure therapy along with surgical and transcatheter approaches that have shown effectiveness in certain subgroups. This review aims to provide insight into current advances in diagnosis and management of SMR.
Topics: Humans; Mitral Valve Insufficiency; Heart Valve Prosthesis Implantation; Mitral Valve; Heart Failure; Cardiac Catheterization; Treatment Outcome
PubMed: 37230646
DOI: 10.1016/j.hfc.2023.02.010 -
Circulation. Heart Failure Sep 2022Functional mitral regurgitation (FMR) can be broadly categorized into 2 main groups: ventricular and atrial, which often coexist. The former is secondary to left... (Review)
Review
Functional mitral regurgitation (FMR) can be broadly categorized into 2 main groups: ventricular and atrial, which often coexist. The former is secondary to left ventricular remodeling usually in the setting of heart failure with reduced ejection fraction or less frequently due to ischemic papillary muscle remodeling. Atrial FMR develops due to atrial and annular dilatation related to atrial fibrillation/flutter or from increased atrial pressures in the setting of heart failure with preserved ejection fraction. Guideline-directed medical therapy is the first step and prevails as the mainstay in the treatment of FMR. In this review, we address the medical therapeutic options for FMR management and highlight a targeted approach for each FMR category. We further address important clinical and echocardiographic characteristics to aid in determining when medical therapy is expected to have a low yield and an appropriate window for effective interventional approaches exists.
Topics: Heart Failure; Humans; Mitral Valve Insufficiency; Papillary Muscles; Stroke Volume; Ventricular Function, Left
PubMed: 35862021
DOI: 10.1161/CIRCHEARTFAILURE.122.009689 -
The Journal of Thoracic and... Jan 2023
Topics: Humans; Mitral Valve; Cardiomyopathy, Hypertrophic; Mitral Valve Insufficiency
PubMed: 33583588
DOI: 10.1016/j.jtcvs.2021.01.046