Key result
Severe AfMR linked to up to ~113% higher mortality vs moderate fMR across multiple definitions.
Why the study?
Severe atrial functional mitral regurgitation lacks a uniform definition across studies, hindering research consolidation, treatment, and clinical guideline establishment.
Does the prognostic significance of severe atrial functional mitral regurgitation for all-cause mortality vary depending on the clinical definition used?
Cohort (n=13,052)
Does the prognostic significance of severe atrial functional mitral regurgitation for all-cause mortality vary depending on the clinical definition used?
Effect estimate: HR 1.34 to 2.13 (95% CI 1.04-1.73 to 1.26-3.61)
p-value: p=0.005 to 0.024
The prognostic significance of severe atrial functional mitral regurgitation varies widely depending on the definition used, highlighting the critical need for a standardized clinical definition.
Definition variability yields inconsistent mortality associations in atrial fMR; leaves optimal severe threshold open for prospective validation.
Background Severe atrial functional mitral regurgitation (AfMR) is a complex and heterogenous disease, lacking a uniform definition. The definition of AfMR, however, varies considerably across studies, particularly concerning the echocardiographic parameters and comorbidities used for inclusion. This heterogeneity across definitions poses a significant challenge to the consolidation of research findings, the proper treatment and the establishment of consistent clinical guidelines. Purpose The objective of this study was to consolidate existing definitions of AfMR and to evaluate the distribution across severe functional mitral regurgitation (fMR), as well as their prognostic significance. Methods All currently used AfMR definitions were applied to our comprehensive clinical database spanning from 2010-2020. This database includes 13,052 patients with fMR, of which 1,163 patients had severe fMR. Survival analysis was performed for each definition, with moderate fMR as the comparator group. Patients with heart failure with reduced ejection fraction were excluded. The primary endpoint was all-cause mortality. Results Overall, 49 different definitions of AfMR were identified. The definitions varied in the number of included patients, with group sizes ranging between 12 and 359 patients. Baseline clinical and echocardiographic characteristics differed markedly between the AfMR cohorts. When compared to moderate fMR, in the univariate analysis 39 definitions had significantly different outcomes, with hazard ratios (HR) ranging from 1.42 (95% CI: 1.11-1.82, p=0.006) to 2.51 (95% CI: 1.49-4.25, p<0.001). After adjustment for age, sex and NT-proBNP, 15 definitions yielded statistically significant results, with HR’s ranging from 1.34 (95% CI: 1.04-1.73, p=0.024) to 2.13 (95% CI: 1.26-3.61, p=0.005) (Figure 1). Conclusion The considerable variation in AfMR definitions across studies has been demonstrated to compromise the comparability of research findings. The results of this study emphasise the necessity for a unified, standardised definition of AfMR in order to enhance consistency in clinical research and practice.
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Koschatko et al. (2026) conducted a cohort in Atrial functional mitral regurgitation (n=13,052). Severe atrial functional mitral regurgitation (various definitions) vs. Moderate functional mitral regurgitation was evaluated on All-cause mortality (HR 1.34 to 2.13, 95% CI 1.04-1.73 to 1.26-3.61, p=0.005 to 0.024). Severe atrial functional mitral regurgitation, depending on the definition used, was associated with varying risks of all-cause mortality compared to moderate fMR (adjusted HRs ranging from 1.34 to 2.13).
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