Author + information
- Received December 8, 2014
- Revision received January 16, 2015
- Accepted February 3, 2015
- Published online March 31, 2015.
- ∗Montreal Heart Institute, Montreal, Quebec, Canada
- †Heart Hospital Baylor Plano, Baylor HealthCare System, Dallas, Texas
- ‡Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Gregg W. Stone, Columbia University Medical Center, The Cardiovascular Research Foundation, 111 East 59th Street, 11th Floor, New York, New York 10022.
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.
- cardiac resynchronization therapy
- heart failure
- mitral valve annuloplasty
Dr. Asgar has served as a consultant for Abbott Vascular. Dr. Mack was a member of the executive committee of the Partner Trial (Edwards Lifesciences, uncompensated); and is co-principal investigator of the Coapt Trial (Abbott Vascular, uncompensated). Dr. Stone has equity in Guided Delivery Systems and Micardia; and is co-principal investigator of the Coapt Trial (Abbott Vascular, uncompensated).
- Received December 8, 2014.
- Revision received January 16, 2015.
- Accepted February 3, 2015.
- 2015 American College of Cardiology Foundation