Vigilance in Mitral Regurgitation
Variation and the Way Forward
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The timing of surgical intervention in primary mitral regurgitation (MR) remains a subject of controversy, as the decision must balance the risks of surgery against the adverse outcomes associated with advanced left ventricular remodeling. To provide clinicians with a management framework, national standards documents identify the presence of symptoms, left ventricular dysfunction, enlarged left ventricular dimensions, and elevated pulmonary pressures as triggers for surgery in chronic severe primary MR.1–3 Achieving optimal outcomes in primary MR rests on the timely identification of these surgical triggers, which, in turn, is incumbent on careful, longitudinal, clinical, and echocardiographic follow-up.2 As such, specific echocardiographic follow-up intervals are recommended for mild, moderate, and severe MR by American College of Cardiology/American Heart Association/European Society of Cardiology guidelines and Appropriate Use Criteria (AUC).1,3,4 Yet, real-world adherence to these recommendations in this group of patients is not clearly known.
See Article by Tanguturi et al
In this issue of the Journal, Tanguturi et al5, in this cleverly designed study, assessed the echocardiographic follow-up intervals used by healthcare providers for monitoring primary MR. This work represents an important effort aiming to understand healthcare delivery and practice patterns in the care of patients with primary MR and evaluating compliance with guideline recommendations.
In the setting of a high-volume center and a reputable echo laboratory, and using a carefully selected population that eliminated most other causes for repeat studies, the investigators found that for severe MR, the mean interval for echocardiographic follow-up was 12.4 months. The mean echocardiographic follow-up intervals for less severe disease were longer: 17 months for moderate MR, 18.3 months for mild MR, and 17.4 months for trace MR. There was considerable variation in intervals based on specialty with primary care physicians in general having the longest …