Optimization of guideline-directed medical treatment to reduce secondary mitral regurgitation: treat the ventricle, not only the valve

This editorial refers to ‘Guideline directed medical therapy and reduction of secondary mitral regurgitation’ by Spinka G. et al., https://doi.org/10.1093/ehjci/jeac068. Secondary mitral regurgitation (SMR) is frequently observed in patients with heart failure with reduced ejection fraction (HFrEF).1,2 In these patients, left ventricular (LV) remodelling results in papillary muscle displacement and tethering of the mitral valve leaflets, thereby disturbing the delicate balance between tethering and closing forces. Significant SMR increases the pulsatile load on the left atrium and the pulmonary vasculature and causes an additional volume overload on the failing LV, thereby increasing diastolic wall stress and accelerating LV adverse remodelling.3,4 It is therefore not surprising that SMR is associated with reduced quality of life as well as an increased risk of heart failure (HF) hospitalization and all-cause mortality.1,2 Significant efforts have been undertaken to reduce SMR severity and improve...