A 44-Year-Old Man Comes to the Office Due to Progressive

A 44-year-old man comes to the office due to progressive shortness of breath over the last 6 months.  The patient says that lately he has been unable to walk even 2 blocks without stopping to rest.  He finds this very unusual as one year ago he used to jog for 2 miles almost daily with no symptoms.  The patient reports no chronic health problems and takes no medications.  He is a lifetime nonsmoker and does not drink alcohol or use illicit drugs.  The patient has no family history of premature cardiovascular disease or sudden cardiac death.  Blood pressure is 138/80 mm Hg and pulse is 85/min and regular.  BMI is 30 kg/m².  Lungs are clear on auscultation.  The point of maximal impulse is displaced to the left.  There is normal splitting of S2 with presence of S3.  A 3/6 holosystolic murmur is heard at the apex following a click.  There are no carotid bruits.  There is trace peripheral edema.  Transthoracic echocardiogram is performed, which shows left ventricular and left atrial dilation.  There is a flail segment of the posterior mitral leaflet with severe eccentric mitral regurgitation.  Left ventricular ejection fraction is 55%.  There are no other significant valvular abnormalities.  Which of the following best describes this patient's condition?

A) Acute mitral regurgitation with normal systolic left ventricular (LV) function
B) Chronic primary mitral regurgitation with impaired systolic LV function
C) Chronic primary mitral regurgitation with normal systolic LV function
D) Chronic secondary mitral regurgitation with impaired systolic LV function
E) Chronic secondary mitral regurgitation with normal systolic LV function