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 April 14th, 2022)


Echocardiographic Criteria to Define Severe MR

Primary mitral regurgitationSecondary mitral regurgitation
Qualitative
MItral valve morphologyFlail leaflet, ruptured pap. muscle, severe retraction, large perforationNormal leaflets but with severe tenting, poor leaflet coaptation
Colour flow jet areaLarge central jet (>50% of LA) or eccentric wall impinging jet of variable sizeLarge central jet (>50% of LA) or eccentric wall impinging jet of variable size
Flow convergenceLarge throughout systoleLarge throughout systole
CW Doppler jetHolosystolic / dense / triangularHolosystolic / dense / triangular
Semiquantitative
Vena contract width (mm)=>7 (=>8 for biplane)=>7 (=>8 for biplane)
Pulmonary vein fowSystolic flow reversalSystolic flow reversal
Mitral flowE-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 ventricleDilated (ESD =>40 mm)Dilated
Left atriumDilated (diameter =>55 mm or volume =>60 mL/m2)Dilated
Zoghbi WA et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography
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