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Table 18. Diagnosis and Medical Therapy in Patients With
Chronic Primary MR
Recommendations
COR LOE
Diagnosis
TTE is indicated for baseline evaluation of LV size and
function, right ventricular (RV) function and LA size,
PA pressure, and mechanism and severity of primary MR
(stages A-D) in any patient suspected of having chronic
primary MR.
I B
CMR is indicated in patients with chronic primary MR to
assess LV and RV volumes, function, or MR severity and
when these issues are not satisfactorily addressed by TTE.
I B
Intraoperative transesophageal echocardiography (TEE)
is indicated to establish the anatomic basis for chronic
primary MR (stages C and D) and to guide repair.
I B
TEE is indicated for evaluation of patients with chronic
primary MR (stages B-D) in whom noninvasive imaging
provides nondiagnostic information about severity of MR,
mechanism of MR, and/or status of LV function.
I C
Exercise hemodynamics with either Doppler
echocardiography or cardiac catheterization is reasonable in
symptomatic patients with chronic primary MR where there
is a discrepancy between symptoms and severity of MR at
rest (stages B and C).
IIa B
Exercise treadmill testing can be useful in patients with
chronic primary MR to establish symptom status and
exercise tolerance (stages B and C).
IIa C
Medical erapy
Medical therapy for systolic dysfunction is reasonable in
symptomatic patients with chronic primary MR (stage D)
and LVEF <60% in whom surgery is not contemplated.
IIa B
Vasodilator therapy is NOT indicated for normotensive
asymptomatic patients with chronic primary MR (stages B
and C1) and normal systolic LV function.
III: No
Benefit
B
Mitral Regurgitation
