Mitral Regurgitation Quantification, Management, and Guidelines: A 2024 Update

Abstract

Abstract A comparison of the recommendations for the diagnosis and treatment of mitral regurgitation (MR), the second-most common valvular heart ailment in high-income countries, from the European Society of Cardiology/European Association for Cardio-Thoracic Surgery 2021 and American College of Cardiology/American Heart Association 2020 guidelines. We systematically reviewed and contrasted the guidelines on the diagnosis and treatment of MR to inform clinical judgment. A multimodal approach comprising a comprehensive history and physical examination, echocardiography, and, in some cases, cardiac magnetic resonance imaging, is the preferred method for diagnosis, treatment guidance, and follow-up in patients with valvular heart disease. Both guidelines agreed on the multidisciplinary approach of the heart team and the definition and grading of severe primary MR. There was substantial agreement on the thresholds for intervention, such as the onset of symptoms, left ventricular failure, and hypertrophy; however, there were differences among asymptomatic individuals with preserved ventricular function. While there was a consensus on the need for intervention in patients with severe secondary MR and those who continued to experience symptoms despite optimization of medical therapy, there was a disagreement regarding whether a transcatheter or surgical repair/replacement should be performed.