MRI in all MR patients: Is this the “Gold Standard” approach?

Mitral regurgitation; MRIMitral regurgitation (MR) can be a real clinical challenge in terms of diagnosis and quantification.Decision making has important prognostic implications for the patient, both in the short and long term.Echocardiography via 2D imaging and Doppler has been a valuable adjunct in the diagnostic and therapeutic approach of patients with MR.However, its application suffers from important caveats, which the clinician should always consider when interpreting its findings.Three-dimensional echocardiography offers new insights in clarifying the complex nature of this disease and addresses the limitations of the traditional 2D method. 1 Recent guidelines have presented several echo parameters for organic MR and fewer parameters for ischemic MR. 2 This emphasizes the difficulty and controversy with processing the obtained data.In everyday practice, we need to combine a variety of parameters to accurately assess a patient with MR, especially for interventional strategies.Measurements of the vena contracta width (VCW), regurgitant volume (RVol) and fraction (RF), and effective regurgitant orifice area (EROA) are recommended in patients with more than mild MR.Although these quantitative techniques can be accurate and reproducible in single centers, there can be significant interobserver variability among centers.Additionally, these methods have inherent limitations, which should be considered when interpreting the echo findings.Left ventricular and atrial dimensions, morphological, and several Doppler parameters as well as pulmonary hypertension are the most important parameters for the final evaluation.Moreover, MR is a dynamic phenomenon and, in obscure cases, we need to combine