Cargando…

Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future

Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is w...

Descripción completa

Detalles Bibliográficos
Autores principales: Onishi, Hirokazu, Izumo, Masaki, Naganuma, Toru, Nakamura, Sunao, Akashi, Yoshihiro J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081364/
https://www.ncbi.nlm.nih.gov/pubmed/35548414
http://dx.doi.org/10.3389/fcvm.2022.883450
_version_ 1784702969673940992
author Onishi, Hirokazu
Izumo, Masaki
Naganuma, Toru
Nakamura, Sunao
Akashi, Yoshihiro J.
author_facet Onishi, Hirokazu
Izumo, Masaki
Naganuma, Toru
Nakamura, Sunao
Akashi, Yoshihiro J.
author_sort Onishi, Hirokazu
collection PubMed
description Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed.
format Online
Article
Text
id pubmed-9081364
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-90813642022-05-10 Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future Onishi, Hirokazu Izumo, Masaki Naganuma, Toru Nakamura, Sunao Akashi, Yoshihiro J. Front Cardiovasc Med Cardiovascular Medicine Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed. Frontiers Media S.A. 2022-04-25 /pmc/articles/PMC9081364/ /pubmed/35548414 http://dx.doi.org/10.3389/fcvm.2022.883450 Text en Copyright © 2022 Onishi, Izumo, Naganuma, Nakamura and Akashi. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Onishi, Hirokazu
Izumo, Masaki
Naganuma, Toru
Nakamura, Sunao
Akashi, Yoshihiro J.
Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title_full Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title_fullStr Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title_full_unstemmed Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title_short Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
title_sort dynamic secondary mitral regurgitation: current evidence and challenges for the future
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081364/
https://www.ncbi.nlm.nih.gov/pubmed/35548414
http://dx.doi.org/10.3389/fcvm.2022.883450
work_keys_str_mv AT onishihirokazu dynamicsecondarymitralregurgitationcurrentevidenceandchallengesforthefuture
AT izumomasaki dynamicsecondarymitralregurgitationcurrentevidenceandchallengesforthefuture
AT naganumatoru dynamicsecondarymitralregurgitationcurrentevidenceandchallengesforthefuture
AT nakamurasunao dynamicsecondarymitralregurgitationcurrentevidenceandchallengesforthefuture
AT akashiyoshihiroj dynamicsecondarymitralregurgitationcurrentevidenceandchallengesforthefuture