Table 10. Diagnosis and Treatment of Patients With
Chronic Secondary MR
Recommendations COR LOE
Diagnosis
TTE is useful to establish the etiolog y of chronic secondary
MR (stages B-D) and the extent and location of wall
motion abnormalities and to assess global LV function,
severity of MR, and magnitude of PHTN.
I C
Noninvasive imaging (stress nuclear/positron emission
tomography, CMR, or stress echocardiography), cardiac
CT angiography, or cardiac catheterization, including
coronary arteriography, is useful to establish etiolog y
of chronic secondary MR (stages B-D) and/or to assess
myocardial viability, which in turn may influence
management of functional MR.
I C
Medical erapy
Patients with chronic secondary MR (stages B-D) and
HF with reduced LVEF should receive standard GDMT
therapy for HF, including ACE inhibitors, AR Bs, beta
blockers, and/or aldosterone antagonists as indicated.
I A
CRT with biventricular pacing is recommended for
symptomatic patients with chronic severe secondary MR
(stages B-D) who meet the indications for device therapy.
I A
Surgical Intervention
MV surgery is reasonable for patients with chronic severe
secondary MR (stages C and D) who are undergoing CABG
or AVR.
IIa C
MV repair or replacement may be considered for severely
symptomatic patients (NYHA class III-IV) with chronic
severe secondary MR (stage D) who have persistent
symptoms despite optimal GDMT for HF.
IIb B
MV repair may be considered for patients with chronic
moderate secondary MR (stage B) who are undergoing other
cardiac surgery.
IIb C
Mitral Regurgitation
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