Extract

This editorial refers to ‘Evolution of secondary mitral regurgitation’ by P.E. Bartko et al., pp. 622--629.

Secondary mitral regurgitation (MR) often develops in heart failure (HF) with either reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF).1,2 In HFrEF, secondary MR develops as a result of a ‘ventricular-secondary’ mechanism, due to dilatation and spherical remodelling of the left ventricle with consequent dilatation of the mitral valve annulus and displacement of the papillary muscles tethering the mitral valve leaflets and preventing them from achieving competent coaptation. Development of left bundle branch block with induced systolic dys-synchrony further increases MR severity.2 In HFpEF, secondary MR develops as a result of an ‘atrial-secondary’ mechanism, due to high left atrial (LA) pressure with consequent dilatation of the left atrium and mitral valve annulus and with or without atrial fibrillation.1,2 An ‘atrial-secondary’ mechanism may also contribute to MR in HFrEF when LA dilatation and/or atrial fibrillation coexist.

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