Key result
Impaired systolic annular contraction (OR 2.18; P=0.001) and saddle deepening (OR 2.68; P=0.04) were independently associated with moderate or greater functional mitral regurgitation in AF patients.
Why the study?
Patients with AF and LA enlargement can develop functional MR without LV remodeling, but annular and LV dynamics in this population were not well defined.
Are abnormal left ventricular mechanics and mitral annular dynamics associated with functional mitral regurgitation in patients with atrial fibrillation?
Observational (n=86)
Are abnormal left ventricular mechanics and mitral annular dynamics associated with functional mitral regurgitation in patients with atrial fibrillation?
In patients with atrial fibrillation, functional mitral regurgitation is associated with impaired left ventricular global longitudinal strain and abnormal systolic mitral annular dynamics, suggesting it is not purely an atrial disorder.
May reflect ventricular-annular contributions to AF-related MR beyond atrial effects; extends atrial-centric models but remains hypothesis-generating.
BACKGROUND: Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS: Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS: The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS: In patients with AF and absent LA contraction, the normal predominantly "atriogenic" annular dynamics become "ventriculogenic." Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. "Atrial" functional MR may not be purely an atrial disorder.
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Tang et al. (2019) conducted an observational in Atrial fibrillation and functional mitral regurgitation (n=86). Impaired systolic annular contraction vs. Normal systolic annular contraction was evaluated on Moderate or more mitral regurgitation (OR 2.18, p=0.001). Impaired systolic annular contraction (OR 2.18; P=0.001) and saddle deepening (OR 2.68; P=0.04) were independently associated with moderate or greater functional mitral regurgitation in AF patients.
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