New guidelines focus on the management of heart failure patients with secondary mitral regurgitation

Secondary mitral regurgitation (SMR) is common among patients with heart failure with reduced ejection fraction (HFrEF), increasing their overall risk of poor outcomes. Managing SMR in these patients can be especially challenging, and four specialty organizations have collaborated on a new position statement designed to provide a renewed sense of clarity.

The Heart Failure Association, European Association of Cardiovascular Imaging, European Heart Rhythm Association and European Association of Percutaneous Cardiovascular Interventions all collaborated on the position statement. Each group is a part of the European Society of Cardiology (ESC), and the final document was published in the ESC’S European Heart Journal.

“The management of heart failure patients with SMR is complex and requires timely referral to a multidisciplinary heart team,” the groups wrote. “Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall heart failure status, and relevant comorbidities.”

The document dives deep into numerous topics, including the pathophysiology of SMR and how imaging providers can best evaluate patients. There’s also a detailed review of key anatomical features associated with SMR.  

The authors also emphasized the importance of treating SMR as a team, noting heart failure specialists, imaging specialists, electrophysiologists, interventional cardiologists and cardiac surgeons should all work together to ensure patients receive the best care possible.

“According to local institutional circumstances, this team should meet regularly, in particular to discuss patients with complex clinical and anatomical characteristics,” the group wrote.

Read the full guideline in European Heart Journal here.