Mitral regurgitation (MR) is the most common valvular heart disease in patients with heart failure (HF) [1]. Left ventricular remodeling, left atrial enlargement, and cardiac dyssynchrony leading to leaflet tethering and/or annular dilatation are the main mechanisms behind secondary MR [2]. Secondary MR is associated with poor outcome in patients with HF and an incremental effect was observed with increasing of MR severity independently from other clinical and echocardiographic parameters [3–7].