Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 73, Issue 19, Pages 2465-2476Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2019.02.061
Keywords
atrial fibrillation; functional mitral regurgitation; heart failure with preserved ejection fraction; mitral annular dilatation; mitral annulus; secondary mitral regurgitation
Categories
Funding
- foundation Limburg Sterk Merk (LSM)
- Hasselt University
- Jessa Hospital
- Medtronic
- Ziekenhuis Oost-Limburg
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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. (c) 2019 by the American College of Cardiology Foundation.
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