Moderate Secondary Mitral Regurgitation: Evolving Evidence and Management Strategies

Secondary mitral regurgitation (SMR) is common in patients with heart failure (HF). Although randomized clinical trials have been focused on the treatment of severe SMR, the prognostic role and potential for treatment of moderate SMR cannot be overlooked. The randomized RESHAPE-HF2 trial included patients with moderate and severe SMR with consistent findings in both groups, raising the hypothesis that transcatheter correction of moderate SMR could have beneficial effects, although this needs further investigation. The aim of this review is to describe the prevalence of moderate SMR in patients with HF, its prognostic impact, and discuss current evidence for pharmacologic and interventional management of patients with moderate SMR.