The asymptomatic patient with mitral regurgitation, new insights into an old problem

A better knowledge of the natural history of valvular disease and the advance in surgical and percutaneous repair techniques are allowing a significant improvement in the prognosis in patients with valvular heart disease. Nonetheless, controversy remains for patients with chronic primary mitral regurgitation (MR).The most controversial decision for patients with chronic MR involves the timing of surgical intervention, although there is an increasing trend toward earlier surgery. Patients my be symptomatic or asymptomatic when left ventricular dysfunction or dilatation is observed. Since echocardiography is, to date, the only diagnostic procedure able to define the nature and the extent of structural changes in patients with MR, it will be the main diagnostic tool in this research, too. Both transthoracic and transesophageal approach will be employed in the assessment of the morphology and the haemodynamics of mitral valve apparatus, as well as the extent of MR and the left ventricular and atrial function. The novel diagnostic modalities, such as stress echocardiography, cardiopulmonary exercise testing three-dimensional echocardiography,inflammatory markers (Interleukin 6), markers of neurohumoral activation (B type natriuretic peptide-BNP,NT-pro-BNP),atrial fibrillation (AF),pulmonary hypertension and resting right ventricular ejection fraction, will be investigated to define the optimal treatment approach and predict complication in patients with asymptomatic chronic MR.