Treatment of Symptomatic Severe Atrial Secondary Mitral Regurgitation with Preserved Left Ventricular Ejection Fraction (≥50%)

This protocol covers the management of symptomatic patients with severe atrial secondary mitral regurgitation (atrial SMR) presenting with preserved left ventricular ejection fraction — a clinically distinct phenotype that requires recognition of its underlying drivers.

Clinical Scenario

The patient has severe atrial secondary mitral regurgitation that is symptomatic, with preserved LVEF (≥50%), characterised by the absence of regional wall motion abnormalities or leaflet tethering. Recognising and addressing the underlying causes of atrial SMR is central to this presentation.

Treatment Approach

Management centres on the optimization of medical therapy, with strategies targeting both the underlying causes of atrial SMR and specific comorbid conditions — rate or rhythm control is among the approaches considered. The full structured regimen and sequencing require the complete protocol.

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References

DOI: 10.1093/eurheartj/ehaf194

preserved LVEF (≥50%) without regional wall motion abnormalities or leaflet tethering; AND TEER may be considered in symptomatic patients with severe atrial SMR not eligible for surgery after optimization of medical treatment including rhythm control, when appropriate.
In patients with atrial SMR, underlying causes need to be recognized and treated.
The use of SGLT2is should be encouraged in patients with HFpEF due to their proven efficacy in reducing cardiovascular death and HF hospitalization.
Limited data show that rhythm control may contribute to reduce atrial SMR severity and reverse LA dilatation.

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