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These patients, designated as having proportionate MR, respond favorably to treatments that lead to reversal of LV remodeling and a decrease in LV volumes (eg, neurohormonal antagonists and LV assist devices), but they may not benefit from interventions that are directed only at the mitral valve leaflets (eg, transcatheter mitral valve repair). In contrast, when ventricular dyssynchrony causes functional MR attributable to unequal contraction of the papillary muscles, the magnitude of regurgitation is greater than that predicted by LV volumes. These patients, designated as having severe but disproportionate MR, respond favorably to treatments that are directed to the mitral valve leaflets or their supporting structures (eg, cardiac resynchronization or transcatheter mitral valve repair), but they may derive little benefit from interventions that act only to reduce LV cavity size (eg, pharmacological treatments). This novel conceptual framework reflects the important interplay between LV geometry and mitral valve function in determining the clinical presentation of patients, and it allows characterization of the determinants of functional MR to guide the most appropriate therapy in the clinical setting.<\/jats:p>","DOI":"10.1161\/circulationaha.119.039612","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T09:00:17Z","timestamp":1556701217000},"page":"779-789","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":66,"title":["Contrasting Effects of Pharmacological, Procedural, and Surgical Interventions on Proportionate and Disproportionate Functional Mitral Regurgitation in Chronic Heart Failure"],"prefix":"10.1161","volume":"140","author":[{"given":"Milton","family":"Packer","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine and the Baylor Scott and White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, TX (M.P., P.A.G.)."},{"name":"Imperial College, London, United Kingdom (M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Grayburn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine and the Baylor Scott and White Heart and Vascular Hospital, Baylor University Medical Center, Dallas, TX (M.P., P.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.06.015"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2011.225789"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew096"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805374"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1806640"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.11.006"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.10.016"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.11.010"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jen188"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1388-9842(03)00105-3"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9149(99)00059-4"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-8703(00)90036-x"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037077"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2009.07.011"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.12.022"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.02.016"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jep184"},{"key":"e_1_3_2_19_2","first-page":"557","article-title":"Early improvement in mitral regurgitation after cardiac resynchronization therapy in cardiomyopathy patients.","volume":"26","author":"Sadeghian H","year":"2017","unstructured":"Sadeghian, H, Lotfi-Tokaldany, M, Montazeri, M, Kazemi Saeed, A, Sahebjam, M, Sardari, A, Ejmalian, G. 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