September 10, 2025ESC Heart Failure1 citationsOpen Access
View Full PaperEpidemiology, pathophysiology, diagnosis and management of atrial functional mitral regurgitation: An expert opinion paper
Key Result
MitraClip treatment for atrial functional mitral regurgitation achieved MR reduction to ≤2+ in 99% of patients at discharge, with a 1 year survival rate exceeding 75%.
Structured PICO
P
Population
Patients with atrial functional mitral regurgitation (AFMR), characterized by left atrial remodelling and mitral annular dilation in the absence of primary mitral valve disease or left ventricular dysfunction, often linked to chronic atrial fibrillation and heart failure with preserved ejection fraction.
I
Intervention
Management strategies including medical therapy (renin-angiotensin system inhibition, SGLT2 inhibitors, GLP-1 receptor agonists, mineralocorticoid receptor antagonists), rhythm control, and surgical or transcatheter interventions.
This expert consensus highlights AFMR as a distinct clinical entity driven by atrial remodeling, emphasizing the need for standardized diagnostic criteria and prospective trials to guide management.
Main Result
Effect estimate: no patients had post-procedural MR ≥ 3+
Limitations
- Limited data from randomized controlled trials specifically for AFMR
- Heterogeneity in definitions of AFMR across studies
Abstract
Abstract Atrial functional mitral regurgitation (AFMR) is an increasingly recognized subtype of mitral regurgitation, characterized by left atrial remodelling and mitral annular dilation in the absence of primary mitral valve disease or left ventricular dysfunction. Closely linked to chronic atrial fibrillation and heart failure with preserved ejection fraction, AFMR is associated with poor clinical outcomes and represents a growing therapeutic challenge. This expert opinion paper summarizes current evidence on the epidemiology, pathophysiology, diagnosis and management strategies, including medical therapy and emerging data supporting surgical and transcatheter interventions in selected patients. However, data from prospective controlled clinical trials are still lacking. Future research is needed to refine patient selection, long‐term outcomes and to support evidence‐based recommendations for this increasingly prevalent condition.