PT  - JOURNAL ARTICLE
AU  - Kamoen, Victor
AU  - Calle, Simon
AU  - De Buyzere, Marc
AU  - Timmermans, Frank
TI  - Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot?
AID  - 10.1136/heartjnl-2020-317040
DP  - 2020 Nov 01
TA  - Heart
PG  - 1719--1725
VI  - 106
IP  - 22
4099  - http://heart.bmj.com/content/106/22/1719.short
4100  - http://heart.bmj.com/content/106/22/1719.full
SO  - Heart2020 Nov 01; 106
AB  - Recent randomised percutaneous mitral intervention trials in patients with heart failure with secondary mitral regurgitation (SMR) have yielded contrasting results. A ‘relative load’ or ‘proportionality’ conceptual framework for SMR has been proposed to partly explain the disparate results. The rationale behind the framework is that SMR depends on the left ventricular dimension and not vice versa. In this review, we provide an in-depth analysis of the proportionality parameters used in this framework and also discuss the regurgitant fraction. We also consider haemodynamic observations in SMR that may affect the interpretation and comparisons among proportionality parameters. The conclusion is that the proportionality concept remains hypothetical and requires prospective validation before envisaging its use at individual patient level for risk stratification or therapeutic decision-making.