Page 141 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

incremental prognostic value over TAPSE. By taking into account TAPSE/PASP ratio (as a measure for RV-PA coupling), it may improve further risk stratification of patients with secondary MR.
Conclusions and future perspectives
Secondary MR is a result of changes in the LV geometry and MV annular dilation and has an increasing incidence. Severe secondary MR is known to be associated with a worse prognosis, whilst the effect of reducing MR on prognosis has still been unclear. The question remains what influences the prognosis of these patients: is it the LV or the valve (i.e. the MR)? Characterization and risk-stratification of patients with secondary MR therefore remains challenging. Until recently the decision to intervene for secondary MR was based also on the LVEF. However, LVEF is subject to many limitations. The conflicting results of two major trials evaluating transcatheter mitral valve repair therapy using the MitraClip device (Abbott Vascular, Menlo, CA) demonstrated differences in LV volumes, but had similarities in LVEF suggesting that LVEF is not the best parameter to assess LV systolic function in patients with secondary MR. Advanced echocardiography, such as speckle tracking echocardiography, from which LVGLS could be derived has shown to be of much more diagnostic and prognostic value in various valvular heart disease and is currently being implemented more in valvular heart disease guidelines. This supports the fact that LVGLS can detect LV dysfunction in an earlier stage and therefore guide physicians to refer patients for intervention before it is too late. Also the mitral valve geometry has an important role in the technical feasibility of intervention, but also could elaborate on which specific transcatheter intervention is more appropriate according to their targets (i.e. leaflets, annulus or sub apparatus). Additionally, multimodality imaging remains key in characterization and quantification of secondary MR and may help further risk-stratification.
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