Summary
Regardless of its etiology, FMR is provoked by progressive remodeling and dysfunction of the left cardiac chambers. Accurate assessment of the dynamic interactions among MV, its entire apparatus and left ventricle/atrium is critically important to help define patient risk and their response to tailored therapies.57,58 GDMT and CRT, when indicated, remain the initial treatment strategy. The exact role of surgical and transcatheter interventions in the treatment of FMR will continue to be elucidated as the recognition of the critical importance of LV geometry in determining valvular function and clinical outcomes evolve. Recently proposed new conceptual framework of proportionate and disproportionate MR help identify which patients benefit from treatments that can decrease LV volumes and reverse LV remodeling (e.g., neurohormonal antagonists) or from interventions that are directed toward the restoration of normal MV function, such as CRT or MV repair, particularly when appropriate annular and adjunct leaflet or subvalvular reconstructions are utilized. Future well-designed RCTs are needed to evaluate the real benefit of surgical or transcatheter repair in FMR.