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Why mitral regurgitation matters

Mitral regurgitation (MR ) is common, undertreated and clinically important1–3

The prevalence of MR significantly increases with age and disproportionately affects older populations4

MR is recognised as the most commonly diagnosed valvular heart disease (VHD), exceeding the prevalence of aortic stenosis.4

prevalence of MR table

Patients may ignore or fail to recognise their symptoms5–10

Dyspnea on exertion

Dyspnoea on exertion

Palpitations

Palpitations

Decreased exercise tolerance

Decreased exercise tolerance

Fatigue

Fatigue

Orthopnea

Orthopnoea

Lower extremity oedema

Lower extremity oedema

Patients with severe MR are often elderly with comorbidities2,11–16

Hypertension

Hypertension

Diabetes

Diabetes

Heart failure

Heart failure (HF)

These factors are also known to increase the risk of complications associated with surgery.13,15,17,18

MR is often detected in acute coronary syndrome (ACS-HF), decompensated HF, hypertensive HF, right HF (RHF), pulmonary oedema and cardiogenic shock patients who are admitted to hospital19

Pulmonary odema

Pulmonary oedema

Cardiogenic shock

Cardiogenic shock

Decompensated HF

Decompensated HF

Hypertensive HF

Hypertensive HF

Right HF

Right HF

ACF-HF

ACF-HF

MR is still undertreated, despite being the second most common form of  VHD in industrialised countries20–23

Valvular heart disease
49% untreated donut

Many patients with severe symptomatic MR go untreated20

79% untreated

Many patients with moderate-to-severe, symptomatic MR and a Class I surgical indication go untreated2

The disease burden of MR extends well beyond the patient’s heart. Patients who have MR have a worse quality of life than people of similar age,26,27 and 42% have one or more comorbidities26

Physical component scores

20% lower

Physical component scores

Mental component scores

8% lower

Mental component scores

The real-life impact of MR on individuals

Dorothy, an inspiring 85-year-old, shares her journey of living with MR following a severe heart attack. As a former president of the American Psychological Association and a passionate mentor for empowering women, Dorothy opens up about the challenges and impact of this condition on her daily life.


Dorothy, retired psychologist, MR patient.

I do not like being impaired, and I felt impaired, I was so weak at that time that, when I got to a corner, I prayed silently that there would be a red light so that I could stop and pause and breathe.

-

Dorothy, retired psychologist, MR patient.

See Dorothy's story
Dorothy, retired psychologist, MR patient.

References

  1. Enriquez-Sarano M, Benfari G, Essayagh B, et al. Mitral regurgitation: Quantify, integrate, and interpret in context. JACC Case Rep. 2022;4(19):1242–1246. doi:10.1016/j.jaccas.2022.08.032.
  2. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet.2018;391(10124):960–969. doi:10.1016/s0140-6736(18)30473-2.
  3. Apostolakis EE, Baikoussis NG. Methods of estimation of mitral valve regurgitation for the cardiac surgeon. J Cardiothorac Surg. 2009;4:34. doi:10.1186/1749-8090-4-34.
  4. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: A population-based study. Lancet. 2006;368(9540):1005–1011. doi:10.1016/s0140-6736(06)69208-8.
  5. BMJ Best Practice. Mitral Regurgitation. Accessed 14 March 2025, https://bestpractice.bmj.com/topics/en-gb/322.
  6. Healthline. What are the stages of mitral valve regurgitation? Accessed 28 February 2025, https://www.healthline.com/health/mitral-regurgitation-stages.
  7. Medanta. What you should know about mitral valve regurgitation. Accessed 28 February 2025, https://www.medanta.org/patient-education-blog/what-you-should-know-about-mitral-valve-regurgitation.
  8. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e72–e227. doi:10.1161/CIR.0000000000000923.
  9. Patient info. Mitral regurgitation. Accessed 28 February 2025, https://patient.info/heart-health/heart-valves-and-valve-disease/mitral-regurgitation.
  10. Walthall H, Diaz L, Harris E, et al. Feasibility and acceptability of using a patient reported outcome measure (OxFAB) to help patients with heart failure to recognise and communicate worsening symptoms to specialist nurses. Eur J Cardiovasc Nurs. 2023;22:i33. doi:doi.org/10.1093/eurjcn/zvad064.105.
  11. Tang SS, Shi R, Zhang Y, et al. Additive effects of mitral regurgitation on left ventricular strain in essential hypertensive patients as evaluated by cardiac magnetic resonance feature tracking. Front Cardiovasc Med. 2022;9:995366. doi:10.3389/fcvm.2022.995366.
  12. Rossi A, Zoppini G, Benfari G, et al. Mitral regurgitation and increased risk of all-cause and cardiovascular mortality in patients with type 2 diabetes. Am J Med. 2017;130(1):70–76. doi:10.1016/j.amjmed.2016.07.016.
  13. Schmitt VH, Geyer M, Born S, et al. Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair. Int J Cardiol Heart Vasc. 2025;56:101601. doi:10.1016/j.ijcha.2025.101601.
  14. Praz F, Brugger N, Kassar M, et al. Interventional treatment of mitral valve regurgitation: an alternative to surgery? Swiss Med Wkly. 2019;149:w20023. doi:10.4414/smw.2019.20023.
  15. Iung B, Urena M. New insights into transcatheter edge-to-edge repair: Filling a gap for undertreatment of primary mitral regurgitation in the elderly? Eur Heart J. 2022. doi:10.1093/eurheartj/ehac039.
  16. Shore S. Mitral regurgitation in heart failure. Accessed 14 March 2025, https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/07/30/15/08/mitral-regurgitation-in-heart-failure.
  17. Crowther M, van der Spuy K, Roodt F, et al. The relationship between pre-operative hypertension and intra-operative haemodynamic changes known to be associated with postoperative morbidity. Anaesthesia. 2018;73(7):812–818. doi:10.1111/anae.14239.
  18. Lerman BJ, Popat RA, Assimes TL, et al. Association Between Heart Failure and Postoperative Mortality Among Patients Undergoing Ambulatory Noncardiac Surgery. JAMA Surgery. 2019;154(10):907–914. doi:10.1001/jamasurg.2019.2110.
  19. Chioncel O, Mebazaa A, Harjola VP, et al. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(10):1242–1254. doi:10.1002/ejhf.890.
  20. Mirabel M, Iung B, Baron G, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–1365. doi:10.1093/eurheartj/ehm001.
  21. Pavon AG, Guglielmo M, Mennilli PM, et al. The role of cardiovascular magnetic resonance in patients with mitral regurgitation. J Cardiovasc Dev Dis. 2022;9(11):399. doi:10.3390/jcdd9110399.
  22. Cecchetto A, Nistri S, Mele D. Primary mitral regurgitation: Answers to clinical cardiologists’ most common questions. Accessed 14 March 2025, https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/primary-mitral-regurgitation-answers-to-clinical-cardiologists-most-common-que.
  23. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43(7):561–632. doi:10.1093/eurheartj/ehab395.
  24. Sorajja P, Leon MB, Adams DH, et al. Transcatheter therapy for mitral regurgitation. Clinical challenges and potential solutions. Circulation. 2017;136(4):404–417. doi:10.1161/circulationaha.117.025264.
  25. Coats AJS, Anker SD, Baumbach A, et al. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J. 2021;42(13):1254–1269. doi:10.1093/eurheartj/ehab086.
  26. Iung B, Baron G, Tornos P, et al. Valvular heart disease in the community: a European experience. Curr Probl Cardiol. 2007;32(11):609–661. doi:10.1016/j.cpcardiol.2007.07.002.
  27. Lim DS, Reynolds MR, Feldman T, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014;64(2):182–192. doi:10.1016/j.jacc.2013.10.021.
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