Chronic ischaemic mitral regurgitation: exercise testing reveals its dynamic componentThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

This editorial refers to ‘Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape’† by V. Giga et al ., on page 1860 Ischaemic mitral regurgitation (IMR) is a complication of coronary heart disease, particularly in the setting of a prior myocardial infarction. Its incidence and clinical importance are largely underestimated partly because physical examination is rather insensitive. IMR occurs despite a structurally normal mitral valve as a consequence of a ventricular disease. It results from distortion of left ventricular (LV) geometry tethering the mitral leaflets and from decreased LV force to close them.1 When present, IMR may exhibit a broad range of severity and conveys a dismal prognosis. The increased mortality risk relates not only to the presence, but also more importantly to the quantified degree of IMR. Several methods can be used to determine the severity of IMR. Semi-quantitative approaches, the colour flow mapping of the regurgitant jet, and the vena contracta width seem to be of limited value, whereas both the Doppler and the PISA methods can quantitate IMR accurately. The effective regurgitant orifice (ERO) area of IMR is the most robust measurement. In the setting of ischaemic heart disease, an ERO ≥20 mm2 is considered severe and associated with excess mortality.2 However, the evaluation of IMR only under resting conditions might underestimate the full impact … *Corresponding author. Tel: +32 4 366 71 94; fax: +32 4 366 71 95. E-mail address : plancellotti{at}chu.ulg.ac.be