Doing away with dogma: increasing afterload to reduce mitral regurgitation.

As heart failure due to coronary and other nonvalvular heart disease becomes more prevalent in the urbanized world, functional mitral regurgitation will become a problem of increasing importance (1). Functional mitral regurgitation, which decreases effort tolerance and worsens prognosis in cardiomyopathy (2,3), is present in most patients referred for cardiac transplantation (4). It is therefore appropriate to direct efforts toward understanding and treating functional mitral regurgitation in cardiomyopathy.