Author + information
- Received October 29, 2018
- Revision received January 8, 2019
- Accepted January 10, 2019
- Published online August 14, 2019.
- Nobuyuki Kagiyama, MD, PhDa,b,∗ (, )
- Sergio Mondillo, MDc,
- Kiyoshi Yoshida, MD, PhDa,
- Giulia Elena Mandoli, MDc and
- Matteo Cameli, MD, PhDc
- aDepartment of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
- bDivision of Cardiology, Washington University in St. Louis, St. Louis, Missouri
- cDepartment of Cardiovascular Diseases, University of Siena, Siena, Italy
- ↵∗Address for correspondence:
Dr. Nobuyuki Kagiyama, West Virginia University Heart and Vascular Institute, 1 Medical Center Drive, Morgantown, West Virginia 26505.
• AFMR is not rare and may be associated with worse prognosis
• Annulus area to leaflet area imbalance and atriogenic tethering are the 2 key mechanisms
• Understanding subtypes of mechanisms may be important in considering therapeutic options
Functional mitral regurgitation (MR) in patients with atrial fibrillation (AF) without left ventricular dysfunction, namely, atrial functional MR, has been increasingly recognized. Whether mitral annular dilatation causes MR in patients without left ventricular dysfunction has remained controversial; however, recent studies using novel imaging technologies, including 3-dimensional echocardiography, have shown that significant functional MR can sometimes occur in AF patients with significant dilatation of mitral annulus and left atrium. Additional contributors such as atriogenic leaflet tethering, annulus area to leaflet area imbalance resulting from insufficient leaflet remodeling and reduced annular contractility, increased valve stress by flattened saddle shape of the annulus, and left atrial dysfunction may be important triggers of atrial functional MR in the presence of dilated mitral annulus and left atrium. The prevalence of atrial functional MR is reported to be between 3% and 15% in AF patients and those with atrial functional MR are associated with worse clinical outcomes. Because there are few published data regarding therapeutic strategies of atrial functional MR, understanding the principles of therapeutic options and their target mechanisms is important with regards to clinical practice until sufficient evidence is established. In this review, the known mechanisms, clinical implications and, when possible, potential therapeutic options of atrial functional MR are discussed.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 29, 2018.
- Revision received January 8, 2019.
- Accepted January 10, 2019.
- 2019 American College of Cardiology Foundation
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