RT Journal Article
SR Electronic
T1 Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot?
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP heartjnl-2020-317040
DO 10.1136/heartjnl-2020-317040
A1 Victor Kamoen
A1 Simon Calle
A1 Marc De Buyzere
A1 Frank Timmermans
YR 2020
UL http://heart.bmj.com/content/early/2020/07/29/heartjnl-2020-317040.abstract
AB Recent randomised percutaneous mitral intervention trials in patients with heart failure with secondary mitral regurgitation (SMR) have yielded contrasting results. A ‘relative load’ or ‘proportionality’ conceptual framework for SMR has been proposed to partly explain the disparate results. The rationale behind the framework is that SMR depends on the left ventricular dimension and not vice versa. In this review, we provide an in-depth analysis of the proportionality parameters used in this framework and also discuss the regurgitant fraction. We also consider haemodynamic observations in SMR that may affect the interpretation and comparisons among proportionality parameters. The conclusion is that the proportionality concept remains hypothetical and requires prospective validation before envisaging its use at individual patient level for risk stratification or therapeutic decision-making.