The Evolving Concept of Secondary Mitral Regurgitation Phenotypes: Lessons From the M-TEER Trials

JACC Cardiovasc Imaging. 2024 Jun;17(6):659-668. doi: 10.1016/j.jcmg.2024.01.012. Epub 2024 Mar 27.

Abstract

Conflicting results from 2 randomized clinical trials of transcatheter mitral valve edge-to-edge repair in secondary mitral regurgitation (SMR) have led to the recognition that SMR is a heterogeneous disease entity presenting with different functional and morphological phenotypes. This review summarizes the current knowledge on SMR caused primarily by atrial secondary mitral regurgitation (aSMR) and ventricular SMR pathology. Although aSMR is generally characterized by severe left atrial enlargement in the setting of preserved left ventricular anatomy and function, different patterns of mitral annular distortion cause different phenotypes of aSMR. In ventricular SMR, the relation of SMR severity to left ventricular dilation as well as the degree of pulmonary hypertension and right ventricular dysfunction are important phenotypic characteristics, which are key for a better understanding of prognosis and treatment response.

Keywords: atrial SMR; functional mitral regurgitation; phenotypes; proportionality; right ventricular dysfunction; secondary mitral regurgitation; ventricular SMR.

Publication types

  • Review

MeSH terms

  • Cardiac Catheterization
  • Echocardiography, Transesophageal
  • Heart Valve Prosthesis Implantation / instrumentation
  • Humans
  • Mitral Valve Insufficiency* / diagnostic imaging
  • Mitral Valve Insufficiency* / etiology
  • Mitral Valve Insufficiency* / physiopathology
  • Mitral Valve Insufficiency* / surgery
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / physiopathology
  • Mitral Valve* / surgery
  • Phenotype*
  • Predictive Value of Tests
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Treatment Outcome
  • Ventricular Function, Left