Cardiovascular Disease: Valvular Heart Disease
Table 2: Staging of Chronic Primary Mitral Regurgitation (MR)*
| Stage | Definition | Mitral Valve (MV) Anatomy | MV Hemodynamics | Hemodynamic Consequences | Symptoms |
| A | 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 |
| B | 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 |
None |
| C | 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 |
None |
| D | 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: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923, accessed 1/16/2024.