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In a multicentre registry including more than 1300 patients with PMR, increased BNP level was an independent predictor of long-term mortality under medical treatment. However, pre-operative BNP activation did not impact long-term mortality after surgical treatment.96
9.1.2.3 Cardiac magnetic resonance and computed tomography
Cardiac magnetic resonance imaging is an alternative to precisely quantify RVol and RF in cases of inconclusive or discordant measurements, and the gold standard to determine cardiac dimensions and chamber volumes.521,522 The combination of planimetered volumetric methods and phase contrast measurement of the MV inflow are used for this purpose.523 In patients with Barlow’s disease and mitral annular disjunction, CMR-detected myocardial fibrosis524 has been associated with ventricular arrhythmias and sudden cardiac death.525
Cardiac computed tomography provides high-resolution anatomical details of the entire MV apparatus523,526 and increasingly plays a role in MV intervention planning, particularly in the assessment of arterial access for extracorporeal circulation and the presence of MV calcification in minimally invasive surgery,527 as well as the feasibility of transcatheter MV implantation (TMVI) based on annulus size and risk of LVOT obstruction.528
≥7 mm (≥8 mm for biplane)
≥ ≤60% ≥ ≥60 mL/m2
≤ 20%−50%
> ≥ moderate
≥40 mm2 (or ≥30 mm2 if elliptical regurgitant orifice area) ≥ ≥ ≥
Figure 10 Echocardiographic assessment of patients with mitral regurgitation. EROA, effective regurgitant orifice area; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; LVOT, left ventricular outflow tract; MR, mitral regurgitation; PMR, primary mitral regurgitation; RF, regurgitant fraction; RVol, regurgitant volume; SMR, secondary mitral regurgitation; SPAP, systolic pulmonary artery pressure; TR, tricuspid regurgitation; VTI, velocity time integral. aSee Table 7 for criteria predicting outcome improvement. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026
