Secondary Mitral Regurgitation Stages A to D
Applies the ACC/AHA chronic SECONDARY mitral regurgitation stages.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Effective regurgitant orifice area, severe at 0.40 or more
- 0.25 square cm
- Coronary disease or cardiomyopathy with a structurally normal valve
- Yes
Result: stage B
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Stage A
- At risk: coronary disease or cardiomyopathy with a structurally normal valve, and no more than a small central jet.
- Stage B
- Progressive: orifice below 0.40 square cm, volume below 60 mL, fraction below 50 percent.
- Stage C
- Asymptomatic severe: orifice 0.40 square cm or more, volume 60 mL or more, or fraction 50 percent or more.
- Stage D
- Severe with heart failure symptoms that persist after revascularization and optimized medical therapy.
- Severe: 0.40, not 0.20
- The 2014 guideline set severe at an orifice of 0.20 square cm and a volume of 30 mL. The 2017 update moved those lines to 0.40 and 60, so that band is moderate now.
- No C1 or C2
- This table does not subdivide asymptomatic severe disease on the ventricle. The dysfunction is the cause of the leak here, not a consequence of it.
- D waits for treatment
- D is not severe plus symptoms. It is symptoms that persist after revascularization and optimization of guideline-directed medical therapy.
- Secondary only
- A structurally normal valve pulled open by remodeling. Prolapse, flail, rheumatic change and endocarditis are primary disease with their own criteria.
What you enter
- Effective regurgitant orifice area, severe at 0.40 or more
- Regurgitant volume, severe at 60 or more
- Regurgitant fraction, severe at 50 or more
- Left ventricular ejection fraction
- Coronary disease or cardiomyopathy with a structurally normal valve
- No more than a small central jet: vena contracta below 0.30 cm
- Heart failure symptoms
- Symptoms persist after revascularization and optimized medical therapy
How this is calculated
Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.