Multimodality Imaging of Mitral Regurgitation

Mitral regurgitation is one of the most common valvular heart diseases and requires an accurate diagnostic approach to define its etiology, mechanism, severity, and therapeutic implications. This review analyzes the integrated role of the main cardiovascular imaging modalities in the assessment of mitral regurgitation. Transthoracic echocardiography (TTE) represents the first-line imaging modality, providing a dynamic assessment of valve anatomy, ventricular function, and hemodynamic consequences, whereas transesophageal echocardiography (TEE) provides complementary high-resolution anatomical characterization. Cardiac magnetic resonance provides accurate quantification of ventricular volumes, the regurgitant volume and fraction, and myocardial remodeling and is particularly useful when echocardiographic findings are inconclusive or discordant. Computed tomography, owing to its high spatial resolution, offers detailed information on the mitral apparatus, annulus, calcifications, and anatomical relationships, supporting the planning of surgical and transcatheter procedures. The integration of echocardiography, CMR, and CT enables more comprehensive risk stratification and personalized treatment selection. The review highlights how multimodality imaging is now essential for guiding the diagnostic and therapeutic pathway, improving intervention timing, the procedural choice, and the overall management of patients with mitral regurgitation.