Functional mitral regurgitation: a proportionate or disproportionate focus of attention?

Abstract

This article refers to 'Impact of mitral regurgitation in patients with worsening heart failure: insights from BIOSTAT-CHF' by M. Pagnesi et al., published in this issue on pages 1750-1758.

Quantified mitral regurgitation and left atrial function in heart failure with reduced ejection fraction: interplay and outcome implications

“…Nevertheless, the potential interplay between PALS and FMR in such a population has not yet been investigated. FMR is a conundrum regarding its pathogenesis, evaluation, and consequences on outcome 28 . Thus, the modulatory role of the left atrium has recently attracted attention as the receptacle of regurgitant volume.…”

“…FMR is a conundrum regarding its pathogenesis, evaluation, and consequences on outcome. 28 Thus, the modulatory role of the left atrium has recently attracted attention as the receptacle of regurgitant volume. Recently, a small study evaluated the potential relationship between FMR severity and LA function defined for total emptying function, showing a worse prognosis in patients encompassing FMR and LA dysfunction.…”

Functional Mitral and Tricuspid Regurgitation across the Whole Spectrum of Left Ventricular Ejection Fraction: Recognizing the Elephant in the Room of Heart Failure

“…Though, the question remains whether the relationship between vFMR and mortality is direct or indirect, assuming that FMR is independently responsible for the outcomes and in all circumstances. On the one hand, a direct relationship between the degree of FMR and mortality has been widely described; on the other hand, several cohort publications stated that FMR was not independently responsible for the poor outcomes observed, suggesting that FMR is a surrogate for another cause of reduced survival [24,33,34]. In very advanced HFrEF, the underlying myocardial impairment and severity of LV dysfunction have a more negative impact on prognosis than FMR [18].…”