Key result
The paradigm shift from secondary to tertiary mitral regurgitation highlights that mitral valve leaflets play an active, maladaptive role in disease progression rather than a passive one.
Why the study?
Secondary MR is undertreated with its prognostic role and indications for correction debated, prompting a critical discussion of the paradigm shift to tertiary MR and the active role of MV leaflets.
This review emphasizes the paradigm shift from secondary to tertiary mitral regurgitation, highlighting the active maladaptive role of mitral valve leaflets and the need for advanced imaging in future interventional studies.
Secondary MR correction indications warrant caution amid ongoing debate; leaves open prospective validation of proportionate/disproportionate phenotypes.
Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into 'proportionate' or 'disproportionate', based on left ventricle (LV) and regurgitant volumes, whereas 'tertiary' MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. We critically discuss the paradigm shift from secondary to tertiary MR and question the notion that MV leaflets play a passive role in secondary MR. We also review the role of standard transthoracic echocardiography for appraising and quantifying maladaptive MV leaflet changes and LV volumes and call for a more sophisticated and comprehensive imaging framework for classifying MR in future interventional studies.
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Landi et al. (2021) conducted a review in Secondary mitral regurgitation. The paradigm shift from secondary to tertiary mitral regurgitation highlights that mitral valve leaflets play an active, maladaptive role in disease progression rather than a passive one.
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