Defining "severe" secondary mitral regurgitation: Emphasizing an integrated approach

Paul A. Grayburn*, Blasé Carabello, Judy Hung, Linda D. Gillam, David Liang, Michael J. Mack, Patrick M. McCarthy, D. Craig Miller, Alfredo Trento, Robert J. Siegel

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

164 Scopus citations


Secondary mitral regurgitation (MR) is associated with poor outcomes, but its correction does not reverse the underlying left ventricular (LV) pathology or improve the prognosis. The recently published American Heart Association/American College of Cardiology guidelines on valvular heart disease generated considerable controversy by revising the definition of severe secondary MR from an effective regurgitant orifice area (EROA) of 0.4 to 0.2 cm2, and from a regurgitant volume (RVol) of 60 to 30 ml. This paper reviews hydrodynamic determinants of MR severity, showing that EROA and RVol values associated with severe MR depend on LV volume. This explains disparities in the evidence associating a lower EROA threshold with suboptimal survival. Redefining MR severity purely on EROA or RVol may cause significant clinical problems. As the guidelines emphasize, defining severe MR requires careful integration of all echocardiographic and clinical data, as measurement of EROA is imprecise and poorly reproducible.

Original languageEnglish (US)
Pages (from-to)2792-2801
Number of pages10
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - Dec 30 2014


  • echocardiography
  • guidelines
  • hemodynamics
  • mitral valve
  • mitral valve insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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