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Functional mitral regurgitation is more a ventricular disease than a valvular disease: insights into rest and exercise pathophysiology Volume 2, issue 6, Novembre-Décembre 2006

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Authors
Soins intensifs cardiologiques, hôpital cardiologique, CHRU Lille, bd du Pr J. Leclercq, 59037 Lille

Functional mitral regurgitation, often silent, is increasingly found with worsening heart failure. One thing is certain: it adversely affects the prognosis of patients with ischemic and nonischemic cardiomyopathy. The main determinants of functional mitral regurgitation are either the local or the global remodeling associated with the left ventricular systolic dysfunction and a synchrony. Increasing papillary muscle tethering forces and reduced left ventricular-generated closing forces compromise the coaptation of the thin mitral leaflets and promote the mitral leak. Functional mitral regurgitation is a dynamic disease. Active myocardial ischemia, myocardial asynchronism and excessive loading conditions worsen mitral regurgitation at rest and during exercise. The therapeutic target in functional mitral regurgitation is finally the impaired left ventricle and not the valve.