Heart Health Heart Disease Treatment Staging of Mitral Regurgitation By Richard N. Fogoros, MD Updated on July 23, 2023 Medically reviewed by Richard N. Fogoros, MD Fact checked by Sarah Scott Print Mitral regurgitation (MR), a “leaky” mitral valve, is the most common type of heart valve disease. Some people with MR often have no symptoms and can remain stable for many years and often for their whole lives. However, in other people, MR eventually produces decompensation of the heart, and heart failure results. In such cases, heart failure may not be reversible. Hero Images / Getty Images The trick to preventing heart failure with MR is to recognize the time when the heart is beginning to decompensate, but before symptoms of heart failure occur. So if you have MR it is very important that you have regular checkups with your healthcare provider to determine the extent of your MR, and to see whether your condition is stable or whether it is getting worse. This process is called "staging" MR. Determining the stage of MR can help you and your healthcare provider decide whether you may need surgical therapy, and, very importantly, to determine the optimal time for surgical therapy should you require it. The Stages of Chronic Mitral Regurgitation Cardiologists divide chronic MR into three "stages." Determining the stage of your MR helps your cardiologist to decide whether and when mitral valve surgery may be needed. The Compensated Stage. In the compensated stage of MR, the heart and the cardiovascular system has “adjusted” to the extra volume load placed on the left ventricle by the damaged valve. The heart compensates by enlarging somewhat, but the dilated heart muscle is otherwise functioning normally. People with compensated MR generally report no symptoms, though their exercise capacity generally turns out to be reduced if a stress test is performed. Many people with mild, chronic MR remain in the compensated stage throughout their lives. The Transitional Stage. For reasons that are not clear, some people with MR will gradually “transition” from a compensated to a decompensated condition. Ideally, valve repair surgery should be performed during this transitional stage, when the risk of surgery is relatively low and the results relatively good. In the transitional stage the heart begins to enlarge, cardiac pressures rise, and the ejection fraction falls. While people in this stage are more likely to report symptoms of dyspnea and poor exercise tolerance, many don’t notice worsening symptoms until their MR has progressed to the third stage. This is a problem, since delaying surgery until the decompensated stage is likely to yield a poor outcome. Many experts believe once atrial fibrillation occurs in the presence of MR, especially if it is associated with dilation of the left atrium, that fact alone ought to indicate that the transitional stage has arrived, and therefore, that valve repair surgery ought to be at least considered. The Decompensated Stage. Those in the decompensated stage almost invariably have very considerable cardiac enlargement, as well as significant symptoms of heart failure. Once the decompensated stage has occurred, cardiomyopathy (damage to the heart muscle ) is present and will remain present even if the mitral valve is repaired. So valve repair surgery becomes quite risky and is not likely to produce an acceptable result. The Importance of Staging MR It is critically important to "catch" the transitional stage of MR before it progresses to the decompensated stage. For this reason, if you have MR you need to have close medical monitoring. Among other things, it is important for your healthcare provider to carefully evaluate whether any new symptoms you may be experiencing are due to MR. In addition, periodic echocardiograms are needed to help your healthcare provider to assess the state of your mitral valve and cardiac chambers. If you have MR, you should make sure your healthcare provider is doing this appropriate monitoring—and you yourself need to pay close attention to any signs of shortness of breath, or a reduced ability to exert yourself. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Arora S, Sivaraj K, Hendrickson M, et al. Prevalence and prognostic significance of mitral regurgitation in acute decompensated heart failure: The ARIC Study. JACC Heart Fail. 2021;9(3):179-189. doi:10.1016/j.jchf.2020.09.015 Grayburn PA, Smith RL. Left ventricular ejection fraction in mitral regurgitation because of flail leaflet. Circ: Cardiovascular Imaging. 2014;7(2):220-221. doi:10.1161/CIRCIMAGING.114.001675 Bakkestrøm R, Banke A, Christensen NL, et al. Hemodynamic characteristics in significant symptomatic and asymptomatic primary mitral valve regurgitation at rest and during exercise. Circ: Cardiovascular Imaging. 2018;11(2):e007171. doi:10.1161/CIRCIMAGING.117.007171 Suri RM, Vanoverschelde JL, Grigioni F, et al. Association between early surgical intervention vs watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA. 2013;310(6):609-616. doi:10.1001/jama.2013.8643 American College of Cardiology. Mitral valve prolapse and mitral valve regurgitation in athletes. Cameli M, Incampo E, Mondillo S. Left atrial deformation: Useful index for early detection of cardiac damage in chronic mitral regurgitation. Int J Cardiol Heart Vasc. 2017;17:17-22. doi:10.1016/j.ijcha.2017.08.003 American Heart Association. Problem: Mitral Valve Regurgitation. European Society of Cardiology. Mitral valve disease: when should we call in the cardiac surgeon?. Additional Reading Bonow, RO, Carabello, BA, Chatterjee, K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523-e661. doi:10.1161/CIRCULATIONAHA.108.190748 Vahanian A, Baumgartner H, et al. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the european society of cardiology. European Heart Journal. 2006;28(2):230-268. doi:10.1093/eurheartj/ehl428 By Richard N. Fogoros, MD Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit