Diagnostic Testing: Routine Follow-Up Recommendations for Diagnostic Testing: Routine Follow-Up for Chronic Primary MR Referenced studies that support the recommendations are summarized in Online Data Supplement 27. COR LOE Recommendations For asymptomatic patients with severe primary MR (Stages B and C1), TTE is indicated every 6 to 12 months for surveillance of LV function (estimated by LVEF, LVEDD, and LVESD) and assessment of pulmonary artery pressure.1 11 In asymptomatic patients with severe primary MR (Stages B and C1), use of serum biomarkers and novel measurements of LV function, such as global longitudinal strain, may be considered as an adjunct to guide timing of intervention.12 21 Synopsis Asymptomatic patients with severe primary MR require periodic TTE to determine optimal timing of interven- tion. Biomarkers and other measures of LV function, such as global longitudinal strain, may also be helpful to guide intervention. Recommendation-Specific Supportive Text 1. TTE provides valuable information for surveillance of LV function (estimated by LVEF and LVESD) and pulmonary artery pressure in asymptomatic patients with severe primary MR (Stage C1) if Chronic severe MR is tolerated poorly, reaching a trigger for surgery at an average rate of about 8% per This progression varies from patient to patient, and because prognosis worsens if cor- rection of MR is delayed beyond the onset of these triggers, referral to a Comprehensive Valve Center for early repair or careful surveillance is of value. Because echocardiographic measure- ments are variable, management decisions that rest on these measurements should be con- firmed by repeat sequential TTE. In patients with milder chronic primary MR (Stages A and B), TTE is indicated periodically to evaluate for changes in MR severity, depending on valve anatomy and other considerations, because regurgitation may worsen over time. 