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
Andrew J S Coats
(1)
,
Stefan D Anker
(2)
,
Andreas Baumbach
(3, 4)
,
Ottavio Alfieri
(5)
,
Ralph Stephan von Bardeleben
(6)
,
Johann Bauersachs
(7)
,
Jeroen J Bax
(8)
,
Serge Boveda
(9)
,
Jelena Čelutkienė
(10)
,
John G Cleland
(11)
,
Nikolaos Dagres
(12)
,
Thomas Deneke
,
Dimitrios Farmakis
(13)
,
Gerasimos Filippatos
(14)
,
Jörg Hausleiter
(15)
,
Gerhard Hindricks
(12)
,
Ewa A Jankowska
(16)
,
Mitja Lainscak
(17)
,
Christoph Leclercq
(18, 19)
,
Lars H Lund
(20)
,
Theresa Mcdonagh
(21)
,
Mandeep R Mehra
(22)
,
Marco Metra
,
Nathan Mewton
(23, 24)
,
Christian Mueller
(25)
,
Wilfried Mullens
(26)
,
Claudio Muneretto
(27)
,
Jean-Francois Obadia
(24)
,
Piotr Ponikowski
(16)
,
Fabien Praz
(28)
,
Volker Rudolph
(29)
,
Frank Ruschitzka
,
Alec Vahanian
(30)
,
Stephan Windecker
(28)
,
Jose Luis Zamorano
(31)
,
Thor Edvardsen
(32)
,
Hein Heidbuchel
(33)
,
Petar M Seferovic
(34)
,
Bernard Prendergast
(35)
1
Warwick Medical School
2 DZHK - German Center for Cardiovascular Research
3 QMUL - Queen Mary University of London
4 YSM - Yale School of Medicine [New Haven, Connecticut]
5 IRCCS San Raffaele Scientific Institute [Milan, Italie]
6 University Medical Center [Mainz]
7 MHH - Medizinische Hochschule Hannover = Hannover Medical School
8 LUMC - Leiden University Medical Center
9 Clinique Pasteur [Toulouse]
10 Vilnius University [Vilnius]
11 University of Glasgow
12 Leipzig University / Universität Leipzig
13 UCY - University of Cyprus [Nicosia]
14 NKUA - National and Kapodistrian University of Athens
15 University-Hospital Munich-Großhadern [München]
16 UWr - University of Wrocław [Poland]
17 University of Ljubljana
18 CIC-IT Rennes
19 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
20 Karolinska University Hospital [Stockholm]
21 King‘s College London
22 HMS - Harvard Medical School [Boston]
23 CIC CHU Lyon (inserm)
24 Hôpital Louis Pradel [CHU - HCL]
25 University Hospital Basel [Basel]
26 ZOL - Ziekenhuis Oost-Limburg
27 UniBs - Università degli Studi di Brescia = University of Brescia
28 Inselspital - Bern University Hospital [Berne]
29 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
30 UPCité - Université Paris Cité
31 UC3M - Universidad Carlos III de Madrid [Madrid]
32 Oslo University Hospital [Oslo]
33 UZA - Antwerp University Hospital [Edegem]
34 University of Belgrade [Belgrade]
35 Guy's and St Thomas' Hospital [London]
2 DZHK - German Center for Cardiovascular Research
3 QMUL - Queen Mary University of London
4 YSM - Yale School of Medicine [New Haven, Connecticut]
5 IRCCS San Raffaele Scientific Institute [Milan, Italie]
6 University Medical Center [Mainz]
7 MHH - Medizinische Hochschule Hannover = Hannover Medical School
8 LUMC - Leiden University Medical Center
9 Clinique Pasteur [Toulouse]
10 Vilnius University [Vilnius]
11 University of Glasgow
12 Leipzig University / Universität Leipzig
13 UCY - University of Cyprus [Nicosia]
14 NKUA - National and Kapodistrian University of Athens
15 University-Hospital Munich-Großhadern [München]
16 UWr - University of Wrocław [Poland]
17 University of Ljubljana
18 CIC-IT Rennes
19 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
20 Karolinska University Hospital [Stockholm]
21 King‘s College London
22 HMS - Harvard Medical School [Boston]
23 CIC CHU Lyon (inserm)
24 Hôpital Louis Pradel [CHU - HCL]
25 University Hospital Basel [Basel]
26 ZOL - Ziekenhuis Oost-Limburg
27 UniBs - Università degli Studi di Brescia = University of Brescia
28 Inselspital - Bern University Hospital [Berne]
29 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
30 UPCité - Université Paris Cité
31 UC3M - Universidad Carlos III de Madrid [Madrid]
32 Oslo University Hospital [Oslo]
33 UZA - Antwerp University Hospital [Edegem]
34 University of Belgrade [Belgrade]
35 Guy's and St Thomas' Hospital [London]
Andrew J S Coats
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Andreas Baumbach
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Serge Boveda
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- ORCID : 0000-0002-8425-3544
Nikolaos Dagres
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Thomas Deneke
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Gerasimos Filippatos
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- ORCID : 0000-0002-5640-0332
Marco Metra
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- ORCID : 0000-0001-6691-8568
Piotr Ponikowski
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Frank Ruschitzka
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Stephan Windecker
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- ORCID : 0000-0003-2653-6762
Bernard Prendergast
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- ORCID : 0000-0002-6031-2124
Résumé
Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology-the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)-presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.