Key result
Circulating and imaging biomarkers hold promise in refining decision-making algorithms for the timing of surgical intervention in patients with asymptomatic severe chronic primary mitral regurgitation.
Why the study?
The timing of surgical intervention in patients who have severe chronic primary mitral regurgitation but remain asymptomatic is often debated.
Circulating and imaging biomarkers can help refine decision-making algorithms for the timing of surgical intervention in patients with asymptomatic severe chronic primary mitral regurgitation.
Answers are grounded in this paper and cite their sources.
Standardizes surgical timing decisions in asymptomatic severe primary MR; reinforces aligned ACC/AHA and ESC/EACTS recommendations for practice and trials.
PURPOSE OF REVIEW: Chronic primary mitral regurgitation (MR) is a common heart valve disease with a rising prevalence with the aging populations worldwide. The timing of surgical intervention in patients who have severe MR but remain asymptomatic is often debated. Herein we synthesize the latest American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/ European Association for Cardio-Thoracic Surgery (ESC/EACTS) heart valve guidelines in such patients and illustrate how circulating and/or imaging biomarkers can be used to help refine decision making algorithms. RECENT FINDINGS: The approach to decision making and strength of guideline recommendations in patients with asymptomatic stage C1 (left ventricular ejection fraction [LVEF] > 60% and left ventricular end systolic dimension [LVESD] < 40 mm) and stage C2 disease (LVEF ≤ 60% and/or LVESD ≥ 40 mm) are reviewed. While surgical intervention is clearly indicated in patients with stage C2 disease, a multifaceted approach that integrates repairability, expertise, sub-clinical evidence of left ventricular (LV) dysfunction, and patient preferences is required to identify the optimal approach to surveillance vs. surgery. The role of imaging (3D echocardiography, contrast echocardiography, left ventricular global longitudinal strain, and cardiovascular magnetic resonance imaging [CMR]) and circulating (natriuretic peptides) biomarkers in decision making is also reviewed. SUMMARY: The decision making around timing of intervention in chronic primary MR requires a personalized approach that is based on accurate assessments of severity of MR, LV dimensions, LV function, valve morphology/repairability, surgeon and center expertise, and patient wishes. Biomarkers hold promise in refining decision making.
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Verma et al. (2023) conducted a review in Asymptomatic severe chronic primary mitral regurgitation. Biomarkers (imaging and circulating) was evaluated. Circulating and imaging biomarkers hold promise in refining decision-making algorithms for the timing of surgical intervention in patients with asymptomatic severe chronic primary mitral regurgitation.
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