Mitral regurgitation - Finding the right time for the right patient- How soon is now?

Valve disease Course resource

20 March 2026

This iHF Course 2026 case-based session focuses on mitral regurgitation in HFrEF (heart failure with reduced ejection fraction). The expert panel discusses the challenges of Guideline-Directed Medical Therapy (GDMT) optimisation, the role of percutaneous mitral valve repair (M-TEER), and the critical timing for intervention.

Clinical decision-making and advanced imaging

The panel analyses a complex case to illustrate clinical decision-making, emphasizing the importance of early identification and accurate imaging. Key diagnostic strategies include:

Advanced echocardiography: Utilising stress and transesophageal echocardiography (TEE) to quantify MR severity.
Hemodynamic assessment: Recognising the immediate impact of MR reduction on blood pressure and central venous pressure.
Tailored strategies: Combining device-based repair with optimised pharmacological approaches, such as using potassium binders to enable MRA initiation.

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Evidence-Based Outcomes: MITRA-FR, COAPT, and RESHAPE-HF2

Trial data, including MITRA-FR, COAPT, and RESHAPE-HF2, highlight the benefits of MR reduction in patients with severe mitral regurgitation and HFrEF. Effective intervention has been shown to:

Reduce Mortality and Hospitalizations
Improve Quality of Life
Enable GDMT Uptitration

The session concludes that early evaluation and intervention, potentially even in patients with less-than-severe MR, may maximize clinical improvement in selected patients.