TY - JOUR
T1 - Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation
T2 - JACC State-of-the-Art Review
AU - Farhan, Serdar
AU - Silbiger, Jeffrey J.
AU - Halperin, Jonathan L.
AU - Zhang, Lily
AU - Dukkipati, Srinivas R.
AU - Vogel, Birgit
AU - Kini, Annapoorna
AU - Sharma, Samin
AU - Lerakis, Stamatios
N1 - Funding Information:
The authors thank Dr Halperin for generously sharing his expertise on atrial fibrillation and valvular heart disease. Special thanks to Dr Silbiger for providing insights on the mechanisms and echocardiographic findings of atrial functional mitral regurgitation. Finally, thanks to Justin Silbiger for assisting with text formatting and to Jill Gregory for creating the illustrations used in this paper.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/12/13
Y1 - 2022/12/13
N2 - The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR—atrial functional MR (AF-MR)—is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.
AB - The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR—atrial functional MR (AF-MR)—is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.
KW - atrial fibrillation
KW - atrial functional mitral regurgitation
KW - atrial functional tricuspid regurgitation
KW - atriogenic leaflet tethering
KW - hamstringing
KW - mitral annulus
UR - http://www.scopus.com/inward/record.url?scp=85142813824&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2022.09.046
DO - 10.1016/j.jacc.2022.09.046
M3 - Review article
AN - SCOPUS:85142813824
SN - 0735-1097
VL - 80
SP - 2314
EP - 2330
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 24
ER -