skip to main content

Proportionate vs Disproportionate MR — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardHeart FailureProportionate vs Disproportionate MREECC

A 58-year-old man with HFrEF (LVEF 32%) and moderate secondary MR is being considered for transcatheter mitral valve repair (TEER). His LVEDV is 180 mL (indexed 92 mL/m²). In view of the COAPT vs MITRA-FR findings, will he benefit from TEER?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — His LV volumes suggest proportionate MR — where the MR is commensurate with the degree of LV dilatation; MITRA-FR enrolled such patients and showed no benefit, unlike COAPT which enrolled patients with disproportionate MR

The divergent results of COAPT (benefit) vs MITRA-FR (no benefit) for TEER in secondary MR have been reconciled by the concept of proportionate vs disproportionate MR. In proportionate MR, the degree of regurgitation is commensurate with the degree of LV dilatation — the MR is a consequence of the LV disease, and fixing the valve does not change the trajectory (MITRA-FR population). In disproportionate MR, the MR severity exceeds what would be expected for the LV size — the valve disease is driving HF symptoms, and fixing it improves outcomes (COAPT population: EROA ≥0.30 cm² with LVEDV <96 mL/m²). This patient's indexed LVEDV of 92 mL/m² with moderate MR suggests proportionate MR, where TEER is less likely to be beneficial.

Reference: ESC/EACTS (2025): VHD Guidelines; COAPT/MITRA-FR Trials