Editorial Support for and Challenges to the Conventional Wisdom Linda D. Gillam, MD, MPH; Leo Marcoff, MD he presence of symptoms in patients with severe pri- at rest and with exercise in patients with asymptomatic or Tmary mitral regurgitation (mitral prolapse/flail) carries symptomatic primary MR. Their results demonstrate directly a class I indication for intervention in current professional what we have inferred from echocardiographic estimates of 1,2 guidelines. However, symptoms may be underappreciated PASP in such patients, but also challenge the conventional because of subconscious curtailment of physical activity, and wisdom of an invariable link between symptoms and pulmo- it may be challenging to differentiate class I (no symptoms) nary pressures. from class II (mild symptoms), particularly when the symp- Their study group is well characterized and meticulously toms are as nonspecific as dyspnea and fatigue—the hallmarks studied, consisting of 57 patients (28 symptomatic and 29 of symptomatic mitral regurgitation (MR). Moreover, it may asymptomatic) with significant primary MR (proximal isove- be impossible to be confident that symptoms are attributable locity surface area-derived effective regurgitant orifice area, to MR when there are cardiac or pulmonary comorbidities. ≥0.30 cm ) and left ventricular ejection fraction >60%. The For these reasons,
Circulation: Cardiovascular Imaging – Wolters Kluwer Health
Published: Feb 1, 2018
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