title: Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations.
abstract: The development of secondary mitral regurgitation (MR) due to left ventricular dysfunction, also known as functional MR, is strongly associated with a poor prognosis in patients with heart failure. The mechanisms underlying secondary MR are multifactorial; accurate imaging assessment of secondary MR may be challenging and nuanced; and the appropriate roles of medical, surgical, and interventional therapies for management of secondary MR are controversial and evolving. In this review, the pathophysiology, evaluation, and prognosis of secondary MR in patients with heart failure are discussed, and we evaluate in detail the evidence for the various therapeutic approaches for secondary MR, including guideline-directed medication for left ventricular dysfunction, cardiac resynchronization therapy and revascularization when appropriate, and mitral valve surgery and transcatheter interventions. The role of a multidisciplinary heart team in determining the optimal management strategy for secondary MR is also discussed.
authors: Montreal Heart Institute, Montreal, Quebec, Canada.
authors: Anita W
authors: AW
authors: Asgar
authors: Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, Texas.
authors: Michael J
authors: MJ
authors: Mack
authors: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York. Electronic address: gs2184@columbia.edu.
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D018450:Disease Progression; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: cardiac resynchronization therapy; echocardiography; heart failure; mitral valve annuloplasty; prognosis; therapy