Current Cardiology Reports

, 16:517 | Cite as

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

  • Mina M. Benjamin
  • Robert L. Smith
  • Paul A. Grayburn
Congestive Heart Failure (J Lindenfeld, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Congestive Heart Failure

Abstract

Functional mitral regurgitation (FMR) occurs when normal or nearly normal mitral leaflets are prevented from proper coaptation by underlying left ventricular (LV) dysfunction, mitral annular dilation, or both. FMR is associated with an adverse prognosis in nonischemic or ischemic LV dysfunction. Multiple studies have confirmed that even mild FMR portends a worse prognosis, and that the risk of FMR is independent of LV volumes and other clinical risk factors. FMR can be difficult to quantitate echocardiographically because it is load dependent and can vary considerably from exam to exam. There is a systematic tendency to underestimate FMR severity by echocardiography because the regurgitant orifice in FMR is typically elliptical, but the formula for calculating regurgitant orifice area assumes circular geometry. Treatment of FMR begins with guideline-directed medical therapy (GDMT) for LV dysfunction and heart failure, including cardiac resynchronization, if indicated. Revascularization should be considered for ischemic FMR, when indicated. Finally, mitral valve surgery should be considered in patients undergoing CABG in whom moderate or greater FMR is present, and also when severe symptomatic FMR persists despite optimal GDMT and revascularization. Percutaneous options for treatment of FMR are in development but are not currently approved in the US.

Keywords

Mitral regurgitation Heart failure Cardiomyopathy 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Mina M. Benjamin declares that he has no conflict of interest. Robert L. Smith declares that he has no conflict of interest. Paul A. Grayburn reports grants and personal fees from Abbott Vascular, grants from Medtronic, grants from Edwards, grants from Aastrom, grants from Guided Delivery Systems, and grants from Valtech Cardio.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Mina M. Benjamin
    • 1
  • Robert L. Smith
    • 3
  • Paul A. Grayburn
    • 1
    • 2
  1. 1.Department of Internal MedicineBaylor University Medical Center, The Heart Hospital Baylor Plano and Baylor Heart and Vascular HospitalDallasUSA
  2. 2.Baylor Heart and Vascular HospitalDallasUSA
  3. 3.Department of Cardiothoracic SurgeryBaylor University Medical Center, The Heart Hospital Baylor Plano and Baylor Heart and Vascular HospitalDallasUSA

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