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Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future
Hirokazu Onishi1,2, Masaki Izumo1, Toru Naganuma1
1Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
Dynamic secondary mitral regurgitation (SMR) in heart failure with reduced ejection fraction (HFrEF) worsens outcomes. Cardiac resynchronization therapy (CRT) and transcatheter edge-to-edge repair (TEER) show promise, but further research is needed.
Area of Science:
- Cardiology
- Cardiovascular Medicine
Background:
- Secondary mitral regurgitation (SMR) is prevalent in heart failure with reduced ejection fraction (HFrEF) and linked to poor clinical outcomes.
- Dynamic SMR, which worsens under stress, significantly reduces exercise capacity and contributes to adverse events.
Purpose of the Study:
- To review current evidence and discuss challenges regarding the management of dynamic SMR in HFrEF.
- To explore the role of non-pharmacological treatments like cardiac resynchronization therapy (CRT) and transcatheter edge-to-edge repair (TEER) for dynamic SMR.
Main Methods:
- Review of existing literature and clinical trial data on dynamic SMR in HFrEF.
- Analysis of the impact of CRT on left ventricular (LV) dyssynchrony and SMR.
- Evaluation of the efficacy of TEER in conjunction with guideline-directed medical therapy (GDMT) and CRT.
Main Results:
- CRT can improve LV dyssynchrony, leading to reduced SMR at rest and during exercise.
- Transcatheter edge-to-edge repair (TEER) combined with GDMT and CRT may be more effective than GDMT and CRT alone in symptomatic HFrEF patients with dynamic SMR.
Conclusions:
- Non-pharmacological management of dynamic SMR remains a challenge.
- Further research is essential to determine the safety and efficacy of various treatment strategies for dynamic SMR in HFrEF.
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