Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week

Sébastien Deferm, Philippe B. Bertrand, Frederik H. Verbrugge, David Verhaert, Filip Rega, James D. Thomas, Pieter M. Vandervoort*

*Corresponding author for this work

Research output: Contribution to journalReview article

14 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2465-2476
Number of pages12
JournalJournal of the American College of Cardiology
Volume73
Issue number19
DOIs
StatePublished - May 21 2019

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Deferm, S., Bertrand, P. B., Verbrugge, F. H., Verhaert, D., Rega, F., Thomas, J. D., & Vandervoort, P. M. (2019). Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week. Journal of the American College of Cardiology, 73(19), 2465-2476. https://doi.org/10.1016/j.jacc.2019.02.061