• mitral regurgitation
• cardiac catheterization and angiography
• transcatheter valve interventions

For symptomatic patients presenting with chronic severe, primary mitral regurgitation, American College of Cardiology/American Heart Association guidelines recommend surgical mitral valve repair for those with ejection fraction ≥30% or consideration of transcatheter mitral valve repair (TMVR) for those with prohibitive surgical risk.1 2 Contemporary clinical trial evidence also suggests benefit of TMVR for patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remain symptomatic despite optimal medical therapy.3

As such, clinicians are often on the lookout for patients with mitral regurgitation and subjective complaints of dyspnoea, fatigue, palpitations as well as objective findings including decreased exercise capacity, elevated left atrial pressure (LAP), elevated pulmonary pressures, atrial fibrillation and/or the presence of abnormal biomarkers including brain natriuretic peptide to inform clinical decision-making.2 In a young, otherwise healthy patient without multisystem disease and multiple concordant clinical and imaging findings consistent with haemodynamically significant mitral regurgitation, decision-making is generally clear-cut. More often than not, clinicians are faced with a nuanced picture involving an older patient with comorbid disease and/or discordant imaging findings. Whether these patients have symptoms of mitral valve regurgitation or some other physiological derangement may not be readily obvious. To what extent these individuals will benefit from mitral valve intervention to reduce mitral regurgitant volume may be equally challenging using contemporary clinical practice recommendations for guidance.

The challenges inherent to evaluating and treating patients presenting with …