The staging of cardiac damage for mitral regurgitation: ready for prime time?

Abstract

Introduction: Mitral regurgitation (MR) is a progressive valvular heart disease (VHD) with significant morbidity and mortality, particularly in older adults. Current guidelines rely primarily on symptom status and LV function to guide intervention, which may underestimate disease severity, especially in asymptomatic patients.

Areas covered: A comprehensive literature search was conducted in PubMed/Medline, Scopus and EMBASE databases for articles until March 2025. This review discusses MR severity grading and introduces the concept of extra-mitral cardiac damage staging, adapted from models used in aortic stenosis. It highlights the application of this staging to both primary and secondary MR, detailing how structural and functional deterioration beyond the mitral valve, such as involvement of the LV, left atrium, pulmonary vasculature, and right ventricle, correlates with outcomes.

Expert opinion: Cardiac damage staging offers a practical, echocardiography-based tool for personalized risk assessment. It allows for the earlier identification of high-risk patients and may shift intervention timing, especially for transcatheter therapies. Despite some variability in staging definitions, its integration into clinical practice could enhance patient stratification and management. Future research should aim to standardize criteria and assess its role in prospective trials, advancing the field toward precision care in VHD.