Management of LVEF 55-60% with Trace Mitral Regurgitation
For an adult patient with LVEF 55-60% and trace mitral regurgitation with no other significant medical history, no intervention is required—this represents normal cardiac function with clinically insignificant valvular disease that warrants routine clinical follow-up only. 1
Clinical Context and Risk Stratification
Your patient's presentation falls well outside the threshold for any intervention:
Trace MR is hemodynamically insignificant and does not meet criteria for even moderate MR (which requires regurgitant fraction <50%, ERO <0.40 cm², vena contracta <0.7 cm, and regurgitant volume <60 mL) 1
LVEF of 55-60% represents preserved ventricular function, though this sits at the lower end of normal range 1
In the context of MR, LVEF measurements can be misleadingly elevated due to reduced afterload from regurgitant flow, but with only trace MR this effect is negligible 2, 3
Recommended Management Approach
No Active Treatment Required
No medical therapy is indicated for asymptomatic patients with trace MR and preserved LVEF 1
Surgical intervention is absolutely not indicated at this stage—surgery is only considered when MR is severe AND accompanied by symptoms, LV dysfunction (LVEF ≤60% with LVESD ≥40mm), new atrial fibrillation, or pulmonary hypertension (PASP >50 mmHg) 1, 4
Surveillance Strategy
Routine clinical follow-up is appropriate:
Annual clinical assessment is sufficient for trace MR with preserved ventricular function 4
Echocardiography every 1-2 years to monitor for any progression of MR severity or changes in ventricular function 4
More frequent monitoring (every 6-12 months) would only be warranted if MR progresses to moderate severity 1
What to Monitor For
Red flags that would change management:
Development of symptoms including dyspnea, decreased exercise tolerance, or fatigue 1, 2
Progression of MR severity to moderate or severe on follow-up echocardiography 1
Decline in LVEF to ≤60% or LVESD ≥40mm, which in the setting of severe MR would trigger surgical referral 1, 4
New-onset atrial fibrillation, which combined with severe MR warrants surgical consideration 4
Development of pulmonary hypertension (PASP >50 mmHg at rest) 4
Progressive left atrial enlargement (LA volume index ≥60 mL/m²) in the context of worsening MR 1
Important Clinical Caveats
Control any hypertension if present, as elevated blood pressure can worsen MR severity even when currently trace 1
If cardiac surgery becomes necessary for another indication (e.g., coronary artery disease), concomitant mitral valve intervention may be considered even for moderate MR, though this is not relevant for trace disease 1, 4
The LVEF of 55-60% deserves attention—while this is technically normal, it sits at the lower threshold, and any decline below 55% should prompt investigation for other causes of cardiomyopathy beyond the trace MR 1