Qualitative
MV morphology
Colour flow MR jet
Flow convergence zonea
CW signal of MR jet
Semi-quantitative
VC width (mm)
Pulmonary vein flow
Mitral inflow
TVI mit /TVI Ao
Quantitative
EROA (mm2)
R Vol (mL)
LV/LA size & spp
| MV morphology |
| Mild |
| Normal/Abnormal |
| Moderate |
| Normal/Abnormal |
| Severe |
| Flail lefleat/Ruptured PMs |
| Colour flow MR jet |
| Mild |
| Small, central |
| Moderate |
| Intermediate |
| Severe |
| Very large central jet or eccentric jet adhering, swirling and reaching the posterior wall of the LA |
| Flow convergence zonea |
| Mild |
| No or small |
| Moderate |
| Intermediate |
| Severe |
| Large |
| CW signal of MR jet |
| Mild |
| Faint/Parabolic |
| Moderate |
| Dense/Parabolic |
| Severe |
| Dense/Triangular |
| VC width (mm) |
| Mild |
| <3 |
| Moderate |
| Intermediate |
| Severe |
| ≥7 (.8 for biplane)b |
| Pulmonary vein flow |
| Mild |
| Systolic dominance |
| Moderate |
| Systolic blunting |
| Severe |
| Systolic flow reversalc |
| Mitral inflow |
| Mild |
| A wave dominantd |
| Moderate |
| Variable |
| Severe |
| E wave dominant (>1.5 m/s)e |
| TVI mit /TVI Ao |
| Mild |
| <1 |
| Moderate |
| Intermediate |
| Severe |
| >1.4 |
| EROA (mm2) |
| Mild |
| <20 |
| Moderate |
| 20–29; 30–39f |
| Severe |
| ≥40 |
| R Vol (mL) |
| Mild |
| <30 |
| Moderate |
| 30–44; 45–59f |
| Severe |
| ≥60 |
| LV and LA size, the systolic pulmonary pressure |
| Unless for other reasons, the LA and LV size and the pulmonary pressure are usually normal in patients with mild MR. In acute severe MR, the pulmonary pressures are usually elevated while the LV size is still often normal. In chronic severe MR, the LV is classically dilated. Accepted cut-off values for non significant left-sided chambers enlargement: LA volume <36 mL/m2, LV end-diastolic diameter <56 mm, LV end-diastolic volume <82 mL/m2, LV end-systolic diameter <40 mm, LV end-systolic volume <30 mL/m2, LA diameter <39 mm, LA volume <29 mL/m2. In secondary MR, an EROA ≥20 mm2 or a R Vol ≥30 mL identifies a subset of patients at increased risk of cardiovascular events. |
CW = continuous-wave; LA = left atrium; EROA = effective regurgitant orifice area; LV = left ventricle; MR = mitral regurgitation; R Vol = regurgitant volume; VC = vena contracta.
aAt a Nyquist limit of 50–60 cm/s - bFor average between apical four- and two-chamber views - cUnless other reasons of systolic blunting (atrial fibrillation, elevated LA pressure) - dUsually after 50 years of age - ein the absence of other causes of elevated LA pressure and of mitral stenosis - fGrading of severity of organic MR classifies regurgitation as mild, moderate or severe, and sub-classifies the moderate regurgitation group into ‘mild-to-moderate’ (EROA of 20–29 mm or a R Vol of 30–44 mL) and ‘moderate-to-severe’ (EROA of 30–39 mm2 or a R Vol of 45–59 mL).