Gaps in Contemporary Echocardiographic Reporting Quality for Mechanisms of Mitral Regurgitation: A Call to Action

Mitral regurgitation (MR) is highly prevalent both in the United States and worldwide and is an important determinant of morbidity and mortality.[1] The mechanisms of MR are divided broadly into primary (affecting valve leaflets) and secondary (affecting nonvalvular structures such as the left ventricle or atrium).2 Mixed MR occurs when primary and secondary mechanisms coexist. In the present study, we refer to “primary degenerative” (e.g., leaflet prolapse and flail) as the type under consideration from a treatment perspective (e.g., rheumatic mitral valve disease is considered relatively less suitable for repair1). Since guideline recommendations for therapeutic options and expected patient outcomes differ by mechanism, proper identification and description of the mechanism of MR are essential to patient care and treatment decisions. [2,3] 

Doppler echocardiography provides the core of the evaluation of valvular regurgitation, and clinician-determined findings are documented in the echocardiographic reports.[2] In addition to the presence and severity of MR, professional multisociety guidelines have defined expectations for echocardiographic reporting, even stating that “one is obligated to describe the mechanism and possible etiologies, particularly in significant regurgitation.”[2] To explore the implementation of these important recommendations in the real-world setting, we developed a natural language processing– (NLP-) based algorithm for identification of relevant descriptors of the mechanism(s) of MR per guidelines by leveraging an extensive database of echocardiographic report data (egnite Database; egnite Inc.).