Mitral regurgitation stages

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Primary Mitral Regurgitation

Stages of Primary Mitral Regurgitation

Shown below is the able depicting stages of mitral regurgitation, adapted from 2014 AHA/ACC guidelines for management of valvular heart disease.[1]

STAGE DEFINITION VALVE ANATOMY VALVE HEMODYNAMICS HEMODYNAMIC CONSEQUENCES SYMPTOMS
A At risk of MR ❑ Mild MVP, normal coaptation
❑ Mild valve thickening with leaflet restriction
❑ No MR jet area OR
❑ Central jet area < 20% LA on doppler
❑ Small vena contracta< 0.3 cm
None None
B Progressive MR ❑ Severe MVP, normal coaptation
❑ Rheumatic valve changes with leaflet restriction,
loss of central coaptation
❑Prior IE
❑ Central jet area 20-40% LA OR
late systolic eccentric jet MR
❑ Vena contracta < 0.7 cm
❑Regurgitant volume < 60 ml
❑ Regurgitant fraction < 50 %
❑ ERO < 0.40 cm2
❑ Angiographic grade 1 - 2+
❑ Mild LA enlargement
❑ No LV enlargement
❑Normal pulmonary pressure
None
C Asymptomatic severe MR ❑ Severe MVP, flail leaflet
❑ Rheumatic valve changes with leaflet restriction,
loss of central coaptation
❑Prior IE

❑ Thickening of leaflets in case of radiation heart disease

❑ Central jet area > 40% LA OR
holosystolic eccentric jet MR
❑ Vena contracta ≥ 0.7 cm
❑Regurgitant volume ≥ 60 ml
❑ Regurgitant fraction ≥ 50 %
❑ ERO ≥ 0.40 cm2
❑ Angiographic grade 3 - 4+
❑ Moderate to severe LA enlargement
❑ LV enlargement
Pulmonary hypertension present at rest or with exercise
C1: LVEF > 60% and LVESD < 40 mm
C2: LVEF ≤ 60 % and LVESD ≥ 40 mm
None
D Symptomatic severe MR ❑ Severe MVP, flail leaflet
❑ Rheumatic valve changes with leaflet restriction,
loss of central coaptation
❑Prior IE

❑ Thickening of leaflets in case of radiation heart disease

❑ Central jet area > 40% LA OR
holosystolic eccentric jet MR
❑ Vena contracta ≥ 0.7 cm
❑Regurgitant volume ≥ 60 ml
❑ Regurgitant fraction ≥ 50 %
❑ ERO ≥ 0.40 cm2
❑ Angiographic grade 3 - 4+
❑ Moderate to severe LA enlargement
❑ LV enlargement
Pulmonary hypertension present
❑ Decreased exercise tolerance
Exertional dyspnea

MR: Mitral regurgitation; MVP: Mitral valve prolapse; IE: Infective endocarditis; LA: Left atrium; ERO: Effective regurgitant orifice; LV: Left ventricle; LVEF: Left ventricular ejection fraction; LVESD: Left ventricular end systolic dimension

References

  1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.