title: Therapeutic decision-making for patients with fluctuating mitral regurgitation.
abstract: Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).
authors: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège, Place du 20 Août 7, 4000 Liège, Belgium.
authors: Patrizio
authors: P
authors: Lancellotti
authors: Cardiac Surgery Unit, GVM Care and Research, Maria Eleonora Hospital, Viale della Regione Siciliana Nord Ovest 1571, Palermo, Italy.
authors: Khalil
authors: K
authors: Fattouch
authors: Echocardiography Unit, Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy.
authors: Giovanni
authors: G
authors: La Canna
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods; D000066491:Clinical Decision-Making / Q000379:methods*; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D015444:Exercise / Q000502:physiology; D006801:Humans; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*