Stages of chronic secondary MR
| Stage | Anatomy | Haemodynamics/LV | Symptoms | |
|---|---|---|---|---|
| A | At risk (asymptomatic) | CAD or cardiomyopathy | No to trace MR— All have primary myocardial disease with LV dilation and reduced EF | Due to coronary ischaemia or heart failure |
| B | Progressive (asymptomatic) | Regional LV dysfx. Annular dilation | Mild to moderate MR: ERO<0.2 cm2 RV<30 mL RF<50% | Symptoms may respond to Rx for coronary ischaemia or HF |
| C | Asymptomatic severe MR | Regional or global LV dilation and dysfx. Leaflet tethering Annular dilation | Severe MR ERO≥0.2 cm2 RV≥50 mL RF≥50% | Symptoms may respond to Rx for coronary ischaemia or HF |
| D | Symptomatic severe MR | Severe MR ERO≥0.2 cm2 RV≥50 mL RF≥50% | HF symptoms persist after revascularisation and medical therapy | |
CAD, coronary artery disease; dysfx, dysfunction; ERO, effective orifice area; HF, heart failure; MR, mitral regurgitation; RF regurgitant fraction; RV, regurgitant volume; Rx, therapy.