Secondary mitral regurgitation (MR) has long been recognized as prognostically important. Even mild MR is associated with adverse outcomes. Yet, surgical trials have not shown improved survival with invasive therapy1 whereas medical therapy and cardiac resynchronization therapy are associated with improved outcomes.2 The 2018 publication of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)3 and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR)4 trials and their apparently discordant results have focused attention on the differences in trial design as well as patient populations.
Hahn RT. Disproportionate Emphasis on Proportionate Mitral Regurgitation—Are There Better Measures of Regurgitant Severity? JAMA Cardiol. Published online February 19, 2020. doi:10.1001/jamacardio.2019.6235
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