Dynamic mitral regurgitation: review of evidence base, assessment and implications for clinical management

Both organic and functional mitral regurgitation are dynamic. Alterations in left ventricular and annular geometry, together with changing loading conditions on exertion, may lead to changes in the severity of mitral regurgitation. Exercise echocardiography is able to identify exercise-induced increases in the severity of mitral regurgitation and pulmonary artery systolic pressure which are responsible for symptoms in patients with mild or moderate dysfunction at rest. Prognostic parameters (exercise induced changes in effective orifice area, ejection fraction, and global longitudinal strain) may help risk-stratify patients with moderate or severe mitral regurgitation who are asymptomatic. This review examines the evidence base for dynamic mitral regurgitation, methods of assessment, clinical implications as well as possible therapies.