Mitral regurgitation (MR), the second most common valvular heart disease, still constitutes a major diagnostic and thera-peutic challenge, due to its complex nature and to its consequences on cardiac remodelling. Life quality and expectancy are determined by the irreversibility of the left ventricular systolic dysfunction, which, despite current guidelines, remains a major drawback. In order to accurately establish “the point of no return” for left ventricular systolic function, the embedment of clinical, biological and imaging data is a requirement. The purpose of this review is to provide an overview of the current multimodal imaging techniques that are useful in correctly assessing patients with MR. Cardiac magnetic resonance strain imaging techniques and 3D echocardiography, in addition to current echocardiographic criteria may help identify the patients who will benefit from early surgery. The technical development of new transcatheter techniques in mitral valve repair could lead to the extension of current guidelines.