Epidemiology, pathophysiology, diagnosis and management of atrial functional mitral regurgitation: An expert opinion paper

Figures

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  Figure 1. Schematic illustration of the pathophysiological mechanisms of AFMR. The figure depicts the anatomical and functional alterations leading to AFMR: left atrial dilation, mitral annular enlargement, atriogenic leaflet tethering and impaired leaflet coaptation. AFMR, atrial functional mitral regurgitation; LA, left atrial; LV, left volume.

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  Figure 2. MR grades over time after mitral valve repair with annuloplasty in patients with atrial functional mitral regurgitation. Prevalence of MR grades over time after mitral valve repair for all patients. Solid lines represent unadjusted estimates of the temporal trend of postoperative MR enclosed within 68% confidence bands: none (green), mild (blue) or moderate or greater (red). Symbols represent data grouped (without regard to repeated measurements) within the time frame to provide a crude verification of model fit. Reproduced from Bakir et al. 75 MR, mitral regurgitation.

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  Figure 3. Management of AFMR. After the diagnosis of AFMR and concomitant HFpEF and/or AF, management involves optimization of medical therapy (i.e., GDMT for HFpEF) and rhythm control strategies for AF (including catheter ablation). In case of persistent symptomatic 3+/4+ AFMR despite optimal therapy and AF management, surgical or percutaneous mitral valve repair may be considered, taking into account the patient's risk profile, comorbidities, need for concomitant procedures and anatomical feasibility. Created in BioRender (https://BioRender.com/9ej8lyx). AF, atrial fibrillation; AFMR, atrial functional mitral regurgitation; CAD, coronary artery disease; GDMT, guideline‐directed medical therapy; HFpEF, heart failure with preserved ejection fraction; LA, left atrial; LAA, left atrial appendage; LV, left ventricular; MR, mitral regurgitation; VHD, valvular heart disease.