26
Mitral Regurgitation
Table 16B. Stages of Secondary MR
Stage Definition Valve Anatomy
A At risk of MR • Normal valve leaflets, chords,
and annulus in a patient
with coronary disease or
cardiomyopathy
B Progressive MR • Regional wall motion
abnormalities with mild tethering
of mitral leaflet
• Annular dilation with mild loss
of central coaptation of the mitral
leaflets
C Asymptomatic severe MR • Regional wall motion
abnormalities and/or LV dilation
with severe tethering of mitral
leaflet
• Annular dilation with severe loss
of central coaptation of the mitral
leaflets
D Symptomatic severe MR • Regional wall motion
abnormalities and/or LV dilation
with severe tethering of mitral
leaflet
• Annular dilation with severe loss
of central coaptation of the mitral
leaflets
a
Several valve hemodynamic criteria are provided for assessment of MR severity, but not all criteria
for each category will be present in each patient. Categorization of MR severity as mild, moderate,
or severe depends on data quality and integration of these parameters in conjunction with other
clinical evidence.
b
e measurement of the proximal isovelocity surface area by 2-dimensional (2D) TTE in patients
with secondary MR underestimates the true ERO because of the crescentic shape of the proximal
convergence.
