Key result
Proportionality framework for secondary mitral regurgitation remains hypothetical and requires prospective validation before clinical use.
Why the study?
Recent randomised percutaneous mitral intervention trials in patients with heart failure with secondary mitral regurgitation yielded contrasting results, leading to a proposed 'proportionality' conceptual framework.
The proportionality framework for secondary mitral regurgitation remains hypothetical and requires prospective validation before clinical application.
Do not apply the proportionality framework to secondary MR decisions yet; leaves open its validity pending prospective trials.
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.
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Kamoen et al. (2020) conducted a review in Heart failure with secondary mitral regurgitation (SMR). Proportionality conceptual framework was evaluated. The proportionality conceptual framework for secondary mitral regurgitation remains hypothetical and requires prospective validation before use in individual patient decision-making.
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