Mitral regurgitation in heart failure with preserved ejection fraction: The interplay of valve, ventricle, and atrium

Abstract

Mitral regurgitation (MR) is highly prevalent among patients with heart failure and preserved ejection fraction (HFpEF). Despite this combination being closely associated with unfavourable outcomes, it remains relatively understudied. This is partly due to the inherent heterogeneity of patients with HFpEF. To address this gap, dissecting HFpEF into mechanism‐based phenotypes may offer a promising avenue for advancing our comprehension of these complex intertwined conditions. This review employs the validated CircAdapt model to explore the haemodynamic implications of moderate to severe MR across a well‐defined spectrum of myocardial disease, characterized by impaired relaxation and reduced myocardial compliance. Both heart failure and mitral valve disease share overlapping symptomatology, primarily attributed to elevated pulmonary pressures. The intricate mechanisms contributing to these elevated pressures are multifaceted, potentially influenced by diastolic dysfunction, left atrial myopathy, and MR. Accurate evaluation of the haemodynamic and clinical impact of MR necessitates a comprehensive approach, taking into account the characteristics of both the left atrium and left ventricle, as well as their intricate interactions, which may currently be underemphasized in diagnostic practice. This holistic assessment is imperative for enhancing our understanding and refining therapeutic strategies within this patient cohort.

What's new in heart failure? June–July 2024

“…Functional mitral regurgitation is common in patients with HF and is associated with worse quality of life and outcomes. [20][21][22] The European Society of Cardiology HF guidelines recommend percutaneous edge-to-edge mitral valve repair in carefully selected patients with FMR who are not eligible for surgery, do not require coronary revascularization, and remain symptomatic despite GDMT. Different classes of recommendation apply to patients who fulfil criteria to achieve a reduction in HF .…”

Mitral regurgitation and heart failure with preserved ejection fraction: Should we treat the muscle, the valve, or both?

“…2 Attention should be paid to correctly diagnose functional MR in the early phases of the HFpEF clinical history to stratify patients at high risk of worse clinical outcomes and to provide effective medical management. 4 To better understand the pathophysiology of MR in the context of HFpEF and improve clinical management, Dhont et al 5 (LV) functional impairment, (2) prevalent LA impairment, and (3) mixed forms (Figure 1).…”