Parameter
Range of values
1. Mitral regurgitation severity
Mild
Moderate (ERO < 20 mm2)
Severe (ERO 20–40 mm2)
Very severe (ERO > 40 mm2)
2. Mitral leaflet tethering
None
Mild (tethering distance < 10 mm)
Severe (tethering distance ≥ 10 mm)
3. Left ventricle viability
Fully viable
Mostly viable (>5 LV segments viable)
Mostly non-viable (≤5 LV segments viable)
4. Left ventricle size
Mildly dilated
Moderately dilated
Severely dilated (LVEDD > 65 mm)
5. Left ventricle function
Mildly impaired
Moderately impaired
Severely impaired (LVEF < 30 %)
Table 16.2
AHA/ACC grading of functional ischemic mitral regugitation severity
Grade | Definition | Valve anatomy | Valve hemodynamics | Associated cardiac findings | Symptoms |
|---|---|---|---|---|---|
A. At risk of MR | Normal valve leaflets, chords, and annulus in a patient with coronary disease or cardiomyopathy | No MR jet or small central jet area <20 % LA on Doppler, Small vena contracta <0.30 cm | Normal or mildly dilated LV size with fixed (infarction) or inducible (ischemia) regional wall motion abnormalities Primary myocardial disease with LV dilation and systolic dysfunction | Symptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy | |
B. Progressive MR | Regional wall motion abnormalities with mild tethering of mitral leaflet. Annular dilation with mild loss of central coaptation of the mitral leaflets | ERO < 0.20 cm2 Regurgitant volume <30 mL Regurgitant fraction <50 % | Regional wall motion abnormalities with reduced LV systolic function. LV dilation and systolic dysfunction due to primary myocardial disease | Symptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy | |
C. Asymptomatic severe MR | Regional wall motion abnormalities and/or LV dilation with severe tethering of mitral leaflet. Annular dilation with severe loss of central coaptation of the mitral leaflets | ERO >0.20 cm2 Regurgitant volume >30 mL Regurgitant fraction >50 % | Regional wall motion abnormalities with reduced LV systolic function LV dilation and systolic dysfunction due to primary myocardial disease | Symptoms due to coronary ischemia or HF may be present that respond to revascularization and appropriate medical therapy | |
D. Symptomatic severe MR | Regional wall motion abnormalities and/or LV dilation with severe tethering of mitral leaflet. Annular dilation with severe loss of central coaptation of the mitral leaflets | ERO >0.20 cm2 Regurgitant volume >30 mL Regurgitant fraction >50 % | Regional wall motion abnormalities with reduced LV systolic function. LV dilation and systolic dysfunction due to primary myocardial disease | HF symptoms due to MR persist even after revascular-ization and optimization of medical therapy. Decreased exercise tolerance. Exertional dyspnea | |
Table 16.3
Recommended interventions according to the severity of ischemic mitral regurgitation and other parameters (when there is an indication for coronary artery revascularisation)
MR severity grade | Other parameters | Interventions |
|---|---|---|
A. At risk of MR | Coronary revascularisation | |
B. Progressive MR | LV all viable
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