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J Am Coll Cardiol. 2019 May 21;73(19):2465-2476. doi: 10.1016/j.jacc.2019.02.061.

Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week.

Author information

1
Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
2
Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium.
3
Department of Cardiac Surgery, Cardiovascular sciences, Leuven University Hospital, Leuven, Belgium.
4
Department of Cardiology, Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois.
5
Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. Electronic address: pieter.vandervoort@zol.be.

Abstract

Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Although both AF and HFpEF-two closely related disease epidemics of the 21st century-are held responsible, current guidelines do not emphasize the need to differentiate atrial functional MR from (ventricular) secondary MR. This review summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights compared with those of secondary MR and suggesting potential therapeutic targets.

KEYWORDS:

atrial fibrillation; functional mitral regurgitation; heart failure with preserved ejection fraction; mitral annular dilatation; mitral annulus; secondary mitral regurgitation

PMID:
31097168
DOI:
10.1016/j.jacc.2019.02.061

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