Written by Andrea Fields MHA, RDCS

ASE’s Mitral Regurgitation Algorithm Simplified!

Now that we have covered all the methods for evaluating mitral regurgitation (MR), let’s put it to use! The ASE released an algorithm as a guide to help determine the severity of chronic MR, using both qualitative, semi-quantitative & quantitative measures.

We understand how crazy this algorithm looks, so we are going to break it down to better understand!

Qualitative & Semi-Quantitative Measures:

We can use these qualitative & semi-quantitative measures to help us determine a baseline assessment for the severity of MR.

The algorithm allows us to easily rule out mild or severe by meeting 4 or more (> 4) of these criteria:

If we can prove > 4 of these criteria, we can confirm if the regurgitation is mild or severe:

If we are only able to meet 2 or 3 of these criteria or values fall in the ‘intermediate’ range, then we need to perform quantitative methods to further determine severity:

Quantitative Measures:

The quantitative methods provide us with the following values:

  1. Effective Regurgitant Orifice Area (EROA)
  2. Regurgitant Volume (RVol)
  3. Regurgitant Fraction (RF)

The algorithm divides the values into 4 grades to help us determine mild, moderate or severe MR.

Let’s break this down these 4 different grades:

What does this mean?!

Items to Note:

  • Algorithm is used for chronic mitral regurgitation
  • Values for EROA are based upon a holosystolic MR jet
  • Patients with low-flow conditions: regurgitant volume (RVol) for chronic MR may be lower


We encourage our readers to utilize this algorithm when determining the severity of chronic mitral regurgitation! If you missed our blog series, covering the qualitative, semi-quantitative and quantitative methods, you can check them out here! Keep an eye out for next week, as we present a case study!

Andrea Fields MHA, RDCS

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Zoghbi, W. A., MD, FASE, & Adams, D., RCS, RDCS, FASE. (2017). Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. JASE, 30, 4th ser., 1-69. Retrieved June 12, 2017.

ASEASE guidelinescardiac chamber quantificationMitral RegurgitationMitral ValveMRMR Algorithm

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Ivan Kyuchukov
Umberto Paradossi
Very useful! Thank you! is it possible to have this in pdf or print it? Umberto Paradossi MD
We are working on an eBook! We will keep you posted.
Rosemary Beles Niesl
I would like more infomation on performing pisa
Check out our recent blog: A Complete Guide to Performing MR PISA!
emad tharwat
thanks alot for all these brillint explanations
Mohammad lbrahim
It's a good algorithm
Najeebullah Sajid
It is good but not new
The algorithm was from the latest ASE guideline paper on valvular regurgitation, released in April 2017. This paper was an update to the 2003 guidelines.
Manoj Sutar
Informative platform
Meena Sumathy
Excellent. Very handy information for students and experts. Keep posting the amazing work.
This page is excellent
It's a good algorithm
Very informative! Just one question. In Mild MR criteria: How does Mitral Valve A-Wave inflow can help us to determine severity of MR?
The ASE guideline paper explains that a dominant A-wave pattern virtually excludes severe MR. We cannot use the A-wave as a single measure of MR severity. It is used as one of the many criteria that collectively would point to mild MR.
Thank you!
costanza goffredo
It's a good algorithm very useful for cardiologyst and students Is possible to have this ineditable form useful for follow-up? thanks
Penyu Dichev
Very useful. Thanks
Penyu Dichev
Very good presentation Thanks!
Penyu Dichev
Thanks Very usefull
Natallia Maroz-Vad.
Well presented systematic approach to diagnosis of MR. But I didn't find "a gold standard". Echo data were compared with echo data, don't be tangled.
Omar Z
A dominant A-wave pattern, means an A-wave bigger than a E-wave? Thanks for your answer and post.
abeer khalil
Very nicely put algorithm. Can you also please present a simplified explanation of Pisa.
Scott Berenhaus
I am soooo glad someone finally simplified this equation/algorithm ..
Very Informative good luck.
Rick Monroe,MD
great sumarization
Are any labs still using stage 1-4 or I-IV for grading mitral regurgitation? I don't see it in the ase documents now and I still see some reports using this grading scheme? Is there a reccomendation from ASE
The four grade classification of MR is still used to quantify MR. The latest MR quantification guideline paper from ASE (2017) references the four grades in the MR severity algorithm. Grade I (mild), Grade II (moderate), Grade III (moderate to severe with EROA 0.3-0.39cm2, RVol 45-59ml, RF 40-49%), Grade IV (severe). Thanks for the question.

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