fig2

Figure 2. Prognostic role of secondary mitral regurgitation and impact of transcatheter mitral valve repair. The impact of transcatheter mitral valve repair on four cohorts of patients with specific clinical phenotypes: (1) The green line indicates patients with disproportionate MR (MR is the “primum movens”) exhibiting both symptoms and mortality reduction (5 COAPT subgroups, 492 patients), including patients with disproportionate MR, symmetrical LV dysfunction, and PM displacement/tenting (e.g., apical anterior AMI); (2) The yellow line indicates patients with proportionate MR reporting unclear prognostic benefit (COAPT subgroup, 56 patients); (3) The red line indicates patients with proportionate MR exhibiting only symptoms reduction (MITRA-FR patients, 304 patients); (4) The purple line indicates advanced HF patients with proportionate MR showing clinical and hemodynamic stabilization (or improvement) as bridge therapy. AMI: acute myocardial infarction; HF: heart failure; HFrEF: heart failure with reduced ejection fraction; HTx: heart transplantation; LBBB: left bundle branch block; LV: left ventricle; LVAD: left ventricular assist device; LVEDV: left ventricle end diastolic volume; LVEF: left ventricle ejection fraction; MI: myocardial infarction; NH: neurohormonal antagonist (beta-blockers, ACE-inhibitors, RAAS blockers, Neprilysin, etc.); PM: papillary muscle; SMR: secondary mitral regurgitation. Adapted and modified from Godino et al.^[7]