{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:30:38Z","timestamp":1788449438260,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into \u2018proportionate\u2019 or \u2018disproportionate\u2019, based on left ventricle (LV) and regurgitant volumes, whereas \u2018tertiary\u2019 MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. We critically discuss the paradigm shift from secondary to tertiary MR and question the notion that MV leaflets play a passive role in secondary MR. We also review the role of standard transthoracic echocardiography for appraising and quantifying maladaptive MV leaflet changes and LV volumes and call for a more sophisticated and comprehensive imaging framework for classifying MR in future interventional studies.<\/jats:p>","DOI":"10.1093\/ehjci\/jeab080","type":"journal-article","created":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T23:35:25Z","timestamp":1618616125000},"page":"835-843","source":"Crossref","is-referenced-by-count":9,"title":["From secondary to tertiary mitral regurgitation: the paradigm shifts, but uncertainties remain"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1083","authenticated-orcid":false,"given":"Antonio","family":"Landi","sequence":"first","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Fulvio","family":"Faletra","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Giulia","family":"Pavon","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Pedrazzini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland"},{"name":"Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Valgimigli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland"},{"name":"Department of Cardiology, Bern University Hospital, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2021072018493994700_jeab080-B1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1038\/nrcardio.2010.202","article-title":"Epidemiology of valvular heart disease in the adult","volume":"8","author":"Iung","year":"2011","journal-title":"Nat Rev Cardiol"},{"key":"2021072018493994700_jeab080-B2","doi-asserted-by":"crossref","first-page":"3515","DOI":"10.1093\/eurheartj\/ehw229","article-title":"Large-scale community echocardiographic screening reveals a major burden of undiagnosed 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