Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness

Clin Res Cardiol. 2021 Nov;110(11):1704-1733. doi: 10.1007/s00392-021-01841-y. Epub 2021 Apr 11.


The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.

Keywords: Echocardiography; Mitral regurgitant orifice area; Mitral regurgitation; PISA method; Quantification; Regurgitant fraction.

Publication types

  • Review

MeSH terms

  • Echocardiography, Doppler, Color / methods*
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Hemodynamics / physiology*
  • Humans
  • Mitral Valve Insufficiency / diagnosis*
  • Mitral Valve Insufficiency / physiopathology
  • Severity of Illness Index