The severity of mitral regurgitation (MR) can be graded based on changes seen on left ventricular angiography.
Method: A catheter is passed along the aorta into the left ventricle and contrast material is released.
Findings on Angiography
Grade
no contrast material enters left atrium
0
a small amount of dye enters left atrium during systole but (a) does not fill the atrium and (b) is cleared progressively with each cardiac contraction
1+
more contrast material enters the left atrium with a few beats, with faint opacification of the left atrium
2+
left atrium becomes well-opacified with a few beats, resulting in a density matching that in the left ventricle
3+
left atrium completely opacified on first systolic contraction
4+
where:
• If there the ejection fraction was 100% then all of the contrast material would be ejected in the first systolic contraction. With severe mitral regurgitation there is a reduced ejection fraction, which means more dye is left to regurgitate into the left atrium.
• In theory the grades could be subdivided (2.5, 3.5) but I am not sure if there is any benefit to this.
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