Cardiovascular Disease: Valvular Heart Disease

sec_arr Table 2: Staging of Chronic Primary Mitral Regurgitation (MR)*
Stage  Definition  Mitral Valve (MV) Anatomy  MV Hemodynamics  Hemodynamic Consequences  Symptoms 
At risk of MR  -Mild MV prolapse 

-Mild MV thickening 

-Mild MV leaflet restriction 

-No MR jet 

-Doppler jet area <20% LA 

Vena contracta <0.3cm 

None  None 
Progressive MR  -Moderate to severe MV prolapse with normal coaptation 



-Doppler jet MR 20-40% LA  

-Vena contracta <0.7cm 

-Regurgitant volume <60ml 

-Regurgitant fraction <50% 

-ERO <40cm2 

-Angiographic grade ≤2+ 

-Mild LA enlargement 

-No LV enlargement 

-Normal PA pressure 

Asymptomatic severe MR  -Severe MV prolapse with loss of normal coaptation or flail leaflet 

-Thickening of leaflets with radiation heart disease 

-Doppler jet MR >40% LA 

-Vena contracta ≥0.7cm 

-Regurgitant volume ≥60ml 

-Regurgitant fraction ≥50% 

-ERO ≥40cm2 

-Angiographic grade >2+ 

-Moderate or severe LA enlargement 

-LV enlargement 

-Pulmonary HTN  

-LVEF >60% and LVESD <40mm 

Symptomatic severe MR  Same as C above  Same as C above  Same as C above   -Reduced exercise tolerance 

-Exertional dyspnea 

ERO – effective regurgitant orifice; HTN – hypertension; LA – left atrium; LV – left ventricle; LVEF – left ventricular ejection fraction; LVESD – left ventricular end-systolic dimension; MR – mitral regurgitation; MV – mitral value, PA – pulmonary artery. 

 *Adapted and modified from Table 17. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2020;143(5):e72-e227. At:, accessed 1/16/2024.