Defining "severe" secondary mitral regurgitation

Emphasizing an integrated approach

Paul A. Grayburn, Blasé Carabello, Judy Hung, Linda Gillam, David Liang, Michael J. Mack, Patrick M. McCarthy, D. Craig Miller, Alfredo Trento, Robert J. Siegel

Research output: Contribution to journalReview article

70 Citations (Scopus)

Abstract

Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm2, and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible.

Original languageEnglish (US)
Pages (from-to)2792-2801
Number of pages10
JournalJournal of the American College of Cardiology
Volume64
Issue number25
DOIs
StatePublished - Dec 30 2014
Externally publishedYes

Fingerprint

Mitral Valve Insufficiency
Guidelines
Heart Valve Diseases
Hydrodynamics
Pathology

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Grayburn, Paul A. ; Carabello, Blasé ; Hung, Judy ; Gillam, Linda ; Liang, David ; Mack, Michael J. ; McCarthy, Patrick M. ; Miller, D. Craig ; Trento, Alfredo ; Siegel, Robert J. / Defining "severe" secondary mitral regurgitation : Emphasizing an integrated approach. In: Journal of the American College of Cardiology. 2014 ; Vol. 64, No. 25. pp. 2792-2801.
@article{cecd76c8003b4c7ab5b20941fdfe60aa,
title = "Defining {"}severe{"} secondary mitral regurgitation: Emphasizing an integrated approach",
abstract = "Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm2, and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible.",
author = "Grayburn, {Paul A.} and Blas{\'e} Carabello and Judy Hung and Linda Gillam and David Liang and Mack, {Michael J.} and McCarthy, {Patrick M.} and Miller, {D. Craig} and Alfredo Trento and Siegel, {Robert J.}",
year = "2014",
month = "12",
day = "30",
doi = "10.1016/j.jacc.2014.10.016",
language = "English (US)",
volume = "64",
pages = "2792--2801",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "25",

}

Grayburn, PA, Carabello, B, Hung, J, Gillam, L, Liang, D, Mack, MJ, McCarthy, PM, Miller, DC, Trento, A & Siegel, RJ 2014, 'Defining "severe" secondary mitral regurgitation: Emphasizing an integrated approach', Journal of the American College of Cardiology, vol. 64, no. 25, pp. 2792-2801. https://doi.org/10.1016/j.jacc.2014.10.016

Defining "severe" secondary mitral regurgitation : Emphasizing an integrated approach. / Grayburn, Paul A.; Carabello, Blasé; Hung, Judy; Gillam, Linda; Liang, David; Mack, Michael J.; McCarthy, Patrick M.; Miller, D. Craig; Trento, Alfredo; Siegel, Robert J.

In: Journal of the American College of Cardiology, Vol. 64, No. 25, 30.12.2014, p. 2792-2801.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Defining "severe" secondary mitral regurgitation

T2 - Emphasizing an integrated approach

AU - Grayburn, Paul A.

AU - Carabello, Blasé

AU - Hung, Judy

AU - Gillam, Linda

AU - Liang, David

AU - Mack, Michael J.

AU - McCarthy, Patrick M.

AU - Miller, D. Craig

AU - Trento, Alfredo

AU - Siegel, Robert J.

PY - 2014/12/30

Y1 - 2014/12/30

N2 - Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm2, and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible.

AB - Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm2, and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible.

UR - http://www.scopus.com/inward/record.url?scp=84919698949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919698949&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2014.10.016

DO - 10.1016/j.jacc.2014.10.016

M3 - Review article

VL - 64

SP - 2792

EP - 2801

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 25

ER -