Abstract
Background: Previous grading and severity scores of MR were based on a mix of objective echocardiographic data and subjective findings such as the presence or absence of symptoms. There is a need for a grade - and a severity -score for Mitral Valve Regurgitation (MR) that is based purely on objective findings and avoids the ambiguity of labelling the same degree of MR differently according to symptoms severity and/or the underlying etiology. Methods: We reviewed published reports regarding MR severity and grades and provided a method for the assessment of MR severity and grades based purely on objective data regardless of the symptom(s) and/or underlying cause(s) of MR. Objective Echocardiographic and/or Cardiac Magnetic Resonance (CMR) findings of Vena Contracta (VC) size in cm2, Effective Regurgitant Orifice area (ERO) in cm2, Effective Regurgitant Volume (ERV) in mls/beat, and Regurgitation Fraction (RF) as a percentage of the left ventricular stroke volume, were given a score value of A, B, C or D with increasing severity, thus ranging from the mildest degree“A” to most severe “D”. Results: As summarized in Table 4, MR severity ranged between 4 “As” to 4 “Ds”. Further elaboration regarding the parameter(s) most severely affected may be added to the score value, e.g., scoring MR with a VC = 0.60 cm2 associated with EROA = 0.4cm2, ERV = 60mls and RF = 45% will be 2D (EROA and ERV) MR, thereby avoiding overlap between various degrees of MR and/or further data manipulation to make other parameters fit one grade of MR or another. Conclusion: Applying this scoring/grading system to Echocardiographic and/or CMR studies of patients with mitral valve regurgitation will enhance our endeavors to use a clear and unified language regarding MR severity without compromising the quality of Echocardiographic or CMR findings and/or reporting.
Highlights
Another significant challenge in quantifying Mitral Valve Regurgitation (MR) is the lack of a protocol that accommodates discordant findings in one or more of the four objective parameters in MR, e.g., MR with Vena Contracta = 0.60 cm2 associated with EROA = 0.4cm2, Effective Regurgitant Volume (ERV) = 55 mls, and Regurgitation Fraction (RF) = 50 mls is -by definition-a mix of moderate and severe MR [4]as well as grade B, C and D primary and secondary MR [4, 5]
We proposed a new method for the assessment of grade and severity of mitral valve regurgitation
MR severity score may range from 4As “mildest” to 4Ds “the most severe” MR
Summary
Significant mitral valve regurgitation (MR) is a growing public health problem with increasing incidence with age, reaching around 15% of all Septogenerians [1]. Considerable degrees of overlap between various levels of quantifications led to the attempted division of moderate MR into two subcategories; mild-to-moderate and moderate-to-severe MR, but even that was not widely accepted [4, 5] Another significant challenge in quantifying MR is the lack of a protocol that accommodates discordant findings in one or more of the four objective parameters in MR, e.g., MR with Vena Contracta = 0.60 cm associated with EROA = 0.4cm, ERV = 55 mls, and RF = 50 mls is -by definition-a mix of moderate and severe MR [4]as well as grade B, C and D primary and secondary MR [4, 5]. There is a need for a grade - and a severity -score for Mitral Valve Regurgitation (MR) that is based purely on objective findings and avoids the ambiguity of labelling the same degree of MR differently according to symptoms severity and/or the underlying etiology
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