de Groot – de Laat LE, et al. - Among patients referred to a tertiary outpatient heart failure (HF) clinic, researchers looked for those in whom HF therapy could be optimized. They also determined how mitral regurgitation (MR) severity was influenced by optimized treatment and investigated for symptom improvement in correlation with MR reduction. On admission and post-optimization of HF therapy following 6–18 months, a total of 47 referred patients with therapy-resistant symptomatic chronic HF with a left ventricular ejection fraction < 40% and at least moderate MR were examined. Following 14 ± 4 months of therapy optimization, 18 (38%) patients had optimal doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker as compared with three (6%) at baseline, and 14 (30%) patients had optimal doses of beta-blockers vs four (9%) at baseline. In over half of the patients, significant MR reduction was seen in correlation with initiation and up-titration of recommended HF therapy. This implies that optimal medical treatment is crucial in these very ill cardiac patients with an otherwise grave prognosis. MR reduction was best correlated to New York Heart Association improvement.