Mitral Regurgitation Severity

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Echocardiographic grading of mitral regurgitation (MR) based on qualitative and quantitative criteria.

Mitral Regurgitation – Severity (ASE 2017, concise)

In general, a transmitral E/A ratio (PW Doppler) < 1 argues against severe mitral regurgitation. The same usually applies if regurgitation is present only during part of systole (non-holosystolic MR). If these features are absent, MR severity should be assessed using an integrative approach, preferably considering the following six pathological criteria:

• Flail leaflet
• Dilated left ventricle with preserved EF
• MR jet occupying >50% of the left atrium (applies to central jets)
• Vena contracta > 7 mm
• PISA radius > 10 mm (aliasing velocity 30–40 cm/s)
• Systolic flow reversal in at least 2 pulmonary veins

Severe mitral regurgitation is present if:

• ≥4 criteria are fulfilled
• ≥3 criteria plus an EROA (by PISA) ≥ 0.3 cm² or a regurgitant volume ≥ 45 mL (PISA or quantitative method)
• ≥2 criteria plus an EROA ≥ 0.4 cm² or a regurgitant volume ≥ 60 mL