The Year in Cardiology

Heart Failure: the Year in Cardiology 2019

John G.F. Cleland; Alexander R. Lyon; Theresa McDonagh; John J.V. McMurray

Disclosures

Eur Heart J. 2020;41(12):1232-1248. 

In This Article

Mitral Regurgitation

COAPT suggested that a percutaneously delivered mitral clip could reduce functional (secondary) regurgitation with a subsequent substantial improvement in morbidity and mortality that was moderately cost-effective in a US healthcare context (US$40 361 per life-year gained and $55 600 per quality-adjusted life year).[65–68] Two-year follow-up of MITRA.fr suggested no benefit.[69] A possible explanation for the apparent discrepancy could be the ratio of the severity of LV dysfunction to the severity of mitral regurgitation. When regurgitation is disproportionate to the severity of LV dysfunction it may drive disease progression and correction may improve outcome.[70,71] When regurgitation is proportionate to the severity of LV dysfunction, fixing the mitral regurgitation may be less useful because myocardial dysfunction drives disease progression. The concept is simple and plausible but application in practice may be difficult. Mitral regurgitation offloads the LV and may mask dysfunction. It is also likely that there is a spectrum of primary and secondary mitral regurgitation, with some patients having a mixed picture. More experience and further data from RCTs may improve patient selection (RESHAPE-HF2: https://clinicaltrials.gov/ct2/show/NCT02444338). However, optimizing guideline-recommended therapy, including diuretic dose, may cause mitral regurgitation secondary to dilation of the LV and mitral ring to improve or resolve. Other technologies for secondary mitral[72] and tricuspid regurgitation[73,74] are being developed.

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