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Table 4 Guideline based reference ranges for grading mr 2014 AHA/ACC Guidelines

From: Echocardiographic assessment of ischemic mitral regurgitation

2014 AHA/ACC Guidelines
Parameter Stage A “At risk” Stage B “Progressive” Stage C “Asymptomatic Severe” Stage D “Symptomatic Severe”
Valve apparatus and anatomy CAD or cardiomyopathy, with normal valve leaflets, chords, annulus Regional WMA with mild tethering of MV Regional WMA ± LV dilatation with severe tethering of MV Regional WMA ± LV dilatation with severe tethering of MV
Annular dilatation with mild loss of central coaptation Annular dilatation with severe loss of central coaptation Annular dilatation with severe loss of central coaptation
LV (ischemic or primary myocardial disease) No or mild dilatation with infarct or inducible ischemia, or cardiomyopathy with LV systolic dysfunction and dilatation Regional WMA with reduced LV systolic function ± dilatation Regional WMA with reduced LV systolic function ± dilatation Regional WMA with reduced LV systolic function ± dilatation
Symptoms May be present, may respond to GDMT May be present, may respond to GDMT May be present, may respond to GDMT Symptoms persist despite GDMT
EROA-CIMR (cm 2 ) < 0.2 < 0.2 ≥ 0.2 ≥ 0.2
Jet/LA area No MR jet or jet area/LA area <20% 20-39% ≥ 40% ≥ 40%
VC width (cm) < 0.3   ≥ 0.7 ≥ 0.7
Regurgitant Fraction   < 50% ≥ 50% ≥ 50%
Regurgitant Volume   < 30 mL ≥ 30 mL ≥ 30 mL