What are the referral criteria for patients with suspected mitral regurgitation to a cardiologist?

Referral criteria for patients with suspected mitral regurgitation to a cardiologist include:

• Adults with moderate or severe mitral valve disease identified on echocardiography should be referred to a specialist cardiologist for assessment and management.
• Adults with a murmur suggestive of valve disease, especially if accompanied by symptoms such as breathlessness or angina, signs like peripheral oedema, or an abnormal ECG, should be offered echocardiography and considered for referral if mitral regurgitation is confirmed.
• Urgent referral (within 2 weeks) to a cardiologist including echocardiography is recommended for adults with a systolic murmur and exertional syncope or severe symptoms (angina or breathlessness on minimal exertion or at rest) thought to be related to valvular heart disease.
• Adults with asymptomatic severe primary mitral regurgitation should be considered for referral if they have any of the following echocardiographic findings: left ventricular ejection fraction (LVEF) less than 60%, end systolic diameter (ESD) more than 45 mm or indexed ESD more than 22 mm/m2, or an increase in systolic pulmonary artery pressure to more than 60 mmHg on exercise testing.
• When deciding on referral for surgery, factors such as valve suitability for repair, presence of atrial fibrillation, or systolic pulmonary artery pressure over 50 mmHg at rest should be taken into account.

These criteria ensure timely specialist assessment and intervention to optimize outcomes in mitral regurgitation.

All recommendations are based on the NICE guideline NG208: Heart valve disease presenting in adults: investigation and management. ¹