Grade | Definition | Valve anatomy | Valve hemodynamics* | Associated cardiac findings | Symptoms |
A | At risk of MR |
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B | Progressive MR |
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C | Asymptomatic severe MR |
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D | Symptomatic severe MR |
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MR: mitral regurgitation; LA: left atrium; LV: left ventricle; HF: heart failure; ERO: effective regurgitant orifice; 2D: two-dimensional; TTE: transthoracic echocardiogram.
* 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 the data quality and integration of these parameters in conjunction with other clinical evidence.
¶ The measurement of the proximal isovelocity surface area by 2D TTE in patients with secondary MR underestimates the true ERO because of the crescentic shape of the proximal convergence. Thus, the 2017 American Society of Echocardiography recommendations for native valvular regurgitation note that the criterion for severe secondary MR may be ≥0.30 cm2 in the presence of an elliptical regurgitant orifice area.Reproduced from: Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252. Table used with the permission of Elsevier Inc. All rights reserved.
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