Investigations
1st investigations to order
transthoracic echo
Test
Visualisation determines severity of valve dysfunction, mechanism, presence of flail, left ventricular size and function, left atrial size, other valvular abnormalities, and right ventricular systolic pressure.[13]
Measurement of left ventricular global longitudinal strain may provide earlier detection of systolic dysfunction than ejection fraction and evidence shows that it may have incremental prognostic value in patients with primary MR treated with surgical repair.[10][11][14][15]
Result
presence and severity of MR; other structural and flow abnormalities
ECG
Test
All patients must undergo ECG examination as a routine screening as well as for any rhythm disturbance (e.g., atrial fibrillation).[13]
Result
may show underlying arrhythmia or prior infarction
Investigations to consider
flow convergence method or proximal isovelocity surface area
Test
Colour Doppler tracks the location of increases in velocity and shows this as a proximal zone of colour aliasing. Analysis of this convergence zone when its shape is hemispheric allows estimation of the surface area of the hemisphere.
Result
location of increases in velocity
colour Doppler flow
Test
Small central jet <4 cm² or <20% of the left atrial area is considered mild.
Vena contracta width <0.3 cm is considered mild; >0.7 cm is considered severe.
Result
severity of flow abnormalities
transoesophageal echocardiogram
Test
May be needed to better assess the severity and aetiology where the degree of symptoms does not match transthoracic echocardiogram findings.[11][21] Additionally, three-dimensional transoesophageal echocardiogram provides a surgical view of the mitral valve, which can help the heart team discussion on intervention strategy.[10][11]
A stress echocardiogram is often useful for determining the severity and impact of the disease on the patient's exercise haemodynamics.
Result
severity and aetiology of MR
cardiac catheterisation
Test
Cardiac catheterisation is used when non-invasive evaluation is inconclusive or discordant with clinical findings.[10][11] It is also used to check for disease in coronary arteries. Patients suspected of having pulmonary hypertension and/or poor left or right ventricular function may have cardiac catheterisation to calculate pulmonary artery pressures and determine level of pulmonary hypertension.
Result
structural, pressure, and flow abnormalities
cardiac magnetic resonance imaging (CMR)
Test
Patients with poor left or right ventricular function and/or mitral annular/leaflet calcification may undergo CMR. Early data using CMR have shown that myocardial fibrosis has been associated with sudden cardiac death and ventricular arrhythmias in primary MR.[22]
Result
structural, pressure, and flow abnormalities
Use of this content is subject to our disclaimer