{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T11:45:57Z","timestamp":1768995957343,"version":"3.49.0"},"reference-count":42,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Mitral regurgitation is the second-most frequent valvular heart disease in Europe after degenerative aortic stenosis. It is associated with significant morbidity and mortality, and its prevalence is expected to increase with population aging. Echocardiography is the first diagnostic approach to assess its severity, constituting a challenging process in which a multimodality evaluation, integrating quantitative, semiquantitative and qualitative methods, as well as a detailed evaluation of the morphology and function of both left ventricle and atria is the key. In this review, we would like to provide a practical diagnosis approach on the mitral valve regurgitation mechanism, severity quantification, and planning of future therapeutic options.<\/jats:p>","DOI":"10.3390\/diagnostics12071717","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T01:57:11Z","timestamp":1657850231000},"page":"1717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Practical Echocardiographic Approach of the Regurgitant Mitral Valve Assessment"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8080-6682","authenticated-orcid":false,"given":"Rebeca","family":"Mu\u00f1oz-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Amelia","family":"Duque-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8357-8155","authenticated-orcid":false,"given":"Aida Tindaya","family":"Igareta-Herraiz","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8065-4271","authenticated-orcid":false,"given":"Mauro","family":"Di Silvestre","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Manuela","family":"Izquierdo-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flor","family":"Baeza-Garz\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Barrag\u00e1n-Acea","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Bosa-Ojeda","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9863-3222","authenticated-orcid":false,"given":"Juan","family":"Lacalzada-Almeida","sequence":"additional","affiliation":[{"name":"Cardiology Unit, University Hospital of the Canary Islands, Tenerife, 38320 San Crist\u00f3bal de La Laguna, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0140-6736(09)60692-9","article-title":"Mitral regurgitation","volume":"373","author":"Akins","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/joa.13196","article-title":"Geometric description for the anatomy of the mitral valve: A review","volume":"237","author":"Oliveira","year":"2020","journal-title":"J. Anat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"G87","DOI":"10.1530\/ERP-20-0034","article-title":"The assessment of mitral valve disease: A guideline from the British Society of Echocardiography","volume":"8","author":"Robinson","year":"2021","journal-title":"Echo Res. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.cjca.2014.06.022","article-title":"Basic Mechanisms of Mitral Regurgitation","volume":"30","author":"Beaudoin","year":"2014","journal-title":"Can. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1016\/j.jacc.2020.02.005","article-title":"2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation","volume":"75","author":"Bonow","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1093\/ehjci\/jeaa322","article-title":"How I look at the regurgitant mitral valve\u2014A stepwise echocardiographic assessment","volume":"22","author":"Dulgheru","year":"2020","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jcmg.2018.01.009","article-title":"Mitral Valve Regurgitation in the Contemporary Era","volume":"11","author":"Reddy","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.pcad.2014.05.010","article-title":"Echocardiography of the Mitral Valve","volume":"57","author":"Zeng","year":"2014","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1016\/j.jaccas.2021.06.029","article-title":"Exercise-Induced Left Bundle Branch Block Resulting in Severe Mitral Regurgitation","volume":"3","author":"Ingraham","year":"2021","journal-title":"JACC Case Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.jacc.2019.02.061","article-title":"Atrial Functional Mitral Regurgitation","volume":"73","author":"Deferm","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","first-page":"858714","article-title":"Management-Oriented Classification of Mitral Valve Regurgitation","volume":"2011","author":"Shah","year":"2011","journal-title":"ISRN Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.jcmg.2020.06.049","article-title":"Basic Principles of the Echocardiographic Evaluation of Mitral Regurgitation","volume":"14","author":"Grayburn","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jjcc.2017.12.005","article-title":"Mechanisms of changes in functional mitral regurgitation by preload alterations","volume":"71","author":"Furukawa","year":"2018","journal-title":"J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/0735-1097(90)90196-V","article-title":"Afterload reduction with vasodilators and diuretics decreases mitral regurgitation during upright exercise in advanced heart failure","volume":"15","author":"Stevenson","year":"1990","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1093\/ehjci\/jet105","article-title":"Recommendations for the echocardiographic assessment of native valvular regurgitation: An executive summary from the European Association of Cardiovascular Imaging","volume":"14","author":"Lancellotti","year":"2013","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s11886-003-0077-1","article-title":"Vena contracta width measurement: Theoretic basis and usefulness in the assessment of valvular regurgitation severity","volume":"5","author":"Tribouilloy","year":"2003","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jcmg.2018.11.006","article-title":"Proportionate and Disproportionate Functional Mitral Regurgitation: A New Conceptual Framework That Reconciles the Results of the MITRA-FR and COAPT Trials","volume":"12","author":"Grayburn","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6969","DOI":"10.21037\/jtd.2018.10.64","article-title":"Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: A review","volume":"10","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.jcmg.2008.05.014","article-title":"Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation: In Vitro Validation and Clinical Experience","volume":"1","author":"Little","year":"2008","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s12410-015-9356-7","article-title":"Real-Time Three-Dimensional Echocardiographic Assessment of Severity of Mitral Regurgitation Using Proximal Isovelocity Surface Area and Vena Contracta Area Method. Lessons We Learned and Clinical Implications","volume":"8","author":"Buck","year":"2015","journal-title":"Curr. Cardiovasc. Imaging Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"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","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.jacc.2008.05.028","article-title":"Effect of Dynamic Flow Rate and Orifice Area on Mitral Regurgitant Stroke Volume Quantification Using the Proximal Isovelocity Surface Area Method","volume":"52","author":"Buck","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.jacc.2014.12.047","article-title":"Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity","volume":"65","author":"Uretsky","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jcmg.2020.06.032","article-title":"Regurgitant Volume\/Left Ventricular End-Diastolic Volume Ratio","volume":"14","author":"NNamazi","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1016\/j.amjcard.2005.12.065","article-title":"Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation","volume":"97","author":"Iwakura","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e018553","DOI":"10.1161\/JAHA.120.018553","article-title":"Optimal Quantification of Functional Mitral Regurgitation: Comparison of Volumetric and Proximal Isovelocity Surface Area Methods to Predict Outcome","volume":"10","author":"Igata","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/0735-1097(94)90867-2","article-title":"A simplified method for determining regurgitant fraction by Doppler echocardiography in patients with aortic regurtitation","volume":"24","author":"Xie","year":"1994","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1056\/NEJMoa1806640","article-title":"Transcatheter mitral-valve repair in patients with heart failure","volume":"379","author":"Stone","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.1016\/j.jacc.2019.09.017","article-title":"Echocardiographic Outcomes After Transcatheter Leaflet Approximation in Patients with Secondary Mitral Regurgitation","volume":"74","author":"Asch","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1056\/NEJMoa1805374","article-title":"Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation","volume":"379","author":"Obadia","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1093\/oxfordjournals.eurheartj.a060390","article-title":"Mitral to aortic velocity-time integral ratio. A non-geometric pulsed-Doppler regurgitant index in isolated pure mitral regurgitation","volume":"15","author":"Tribouilloy","year":"1994","journal-title":"Eur. Heart J."},{"key":"ref_33","first-page":"616","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"52","author":"Falk","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S0002-9149(98)00909-6","article-title":"Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation","volume":"83","author":"Dujardin","year":"1999","journal-title":"Am. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1093\/ehjci\/jew190","article-title":"The clinical use of stress echocardiography in non-ischaemic heart disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography","volume":"17","author":"Lancellotti","year":"2016","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1161\/CIRCULATIONAHA.110.938241","article-title":"Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation","volume":"122","author":"Magne","year":"2010","journal-title":"Circulation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/2211-4122.117979","article-title":"Dynamic ischaemic mitral regurgitation and the role of stress echocardiography","volume":"23","author":"Pierard","year":"2013","journal-title":"J. Cardiovasc. Echogr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s12574-018-0404-6","article-title":"Prognostic value of exercise stress echocardiography in patients with secondary mitral regurgitation: A long-term follow-up study","volume":"17","author":"Suzuki","year":"2018","journal-title":"J. Echocardiogr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.amjcard.2018.10.024","article-title":"Meta-analysis comparing mitral valve repair versus replacement for degenerative mitral regurgitation across all ages","volume":"123","author":"Jung","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1067\/mje.2002.121534","article-title":"Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair","volume":"15","author":"Omran","year":"2002","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.echo.2020.01.012","article-title":"Adult Intraoperative Echocardiography: A Comprehensive Review of Current Practice","volume":"33","author":"Thaden","year":"2020","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1093\/ehjci\/jet060","article-title":"Peri-interventional echo assessment for the MitraClip procedure","volume":"14","author":"Wunderlich","year":"2013","journal-title":"Eur. Heart J.-Cardiovasc. 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