Mitral Valve Regurgitation Calculator
Perform online calculations to determine the Class of Recommendation for Mitral Valve Regurgitation Intervention according to Guidelines
March 15th, 2022
(updated December 14th, 2024)
How to use the Calculator. The Calculator is an Excel file: type in the yellow cells the information requested, checking the Legend provided in or below the Calculator box for explanations concerning the variable values. The Calculator will instantly calculate the results of formulas in the gray cells, and provide the COAPT Criteria, and Surgical Indication and Recommendation Class.
The Calculator is based on the recently published 2021 European Guidelines for the management of valvular heart disease.
Echocardiographic Criteria to Define Severe MR
| Primary mitral regurgitation | Secondary mitral regurgitation | |
|---|---|---|
| Qualitative | ||
| MItral valve morphology | Flail leaflet, ruptured pap. muscle, severe retraction, large perforation | Normal leaflets but with severe tenting, poor leaflet coaptation |
| Colour flow jet area | Large central jet (>50% of LA) or eccentric wall impinging jet of variable size | Large central jet (>50% of LA) or eccentric wall impinging jet of variable size |
| Flow convergence | Large throughout systole | Large throughout systole |
| CW Doppler jet | Holosystolic / dense / triangular | Holosystolic / dense / triangular |
| Semiquantitative | ||
| Vena contract width (mm) | =>7 (=>8 for biplane) | =>7 (=>8 for biplane) |
| Pulmonary vein fow | Systolic flow reversal | Systolic flow reversal |
| Mitral flow | E-wave dominant (>1.2 m/s) | E-wave dominant (>1.2 m/s) |
| VTI mitral / aortic | >1.4 | >1.4 |
| Quantitative | ||
| EROA (2D PISA, mm2) | =>40 | =>40 (may be =>30 if elliptical regurgitant orifice area) |
| Regurgitant volume (ml) | =>60 | =>60 (may be =>45 if low flow conditions) |
| Regurgitant fraction (%) | =>50 | =>50 |
| Structural | ||
| Left ventricle | Dilated (ESD =>40 mm) | Dilated |
| Left atrium | Dilated (diameter =>55 mm or volume =>60 mL/m2) | Dilated |
developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017;30:303371.
Legend
- Acute / Chronic
- MR Grade
- Symptoms
- Mechanism (Primary / Secondary)
- GDMT
- Experienced Center with HT
- Surgical risk
- Eligible for surgery
- Results of repair surgery durable
- Futility
- Severe comorbidities
- Severe frailty
- Non dilative/ischemic CM with HF
- Infiltrative CM
- Life expectancy < 1 year
- New onset of atrial fibrillation
- Concomitant open heart surgery
- End stage LV / RV failure
- Right-sided CHF with mod/sev RV dysfunction
- High BNP
- ≥1 HF hospitalization previous year
- Acute= 1 / Chronic= 2
- Trace= 1 / Mild= 2 / Moderate= 3 / Severe= 4
- No= 0 / Yes= 1
- Primary= 1 / Secondary= 2
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- Low= 1 / Internediate= 2 / High= 3
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
- No= 0 / Yes= 1
Abbreviations
- BNP: B-type Natriuretic Peptide
- BSA: Body Surface Area
- CHF: Congestive Heart Failure
- CM: Cardiomyopathy
- COAPT: Cardiovascular Putcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation
- ESD: End-Systolic Diameter
- EF: Ejection Fraction
- GMDT: Guideline Directed Medical Therapy
- GLS: Global Longitudinal Strain
- HT: Heart Team
- LA: Left Atrial
- LV: Left Ventricular
- MV: Mitral Valve
- RV: Right Ventricular
- TEER: Transcatheter Edge-to-Edge Repair
- VTI: Velocity-Time Integral