Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men

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  Figure 1. Differents factors contribute to the occurrence of AMR and ATR. The most frequent substrate is AF, which leads to atrial and atrioventricular annulus dilation. HFpEF also elicits AMR and ATR, due to left and right atrial dilation as a result of pressure overload, and also constitutes a frequent trigger for AF. *denotes other variables or mechanisms, which may contribute to the occurrence of AMR, like hypervolemia, hamstringing of the posterior mitral leaflet or insufficient leaflet growth. # denotes other variables or mechanisms, which may contribute to the occurrence of ATR, like older age, hypervolemia, pulmonary hypertension, intracardiac lead or insufficient leaflet growth. Prevalence data and suggested pathophysiologic mechanisms indicate that female patients are at higher risk for these heart valve disorders. AMR, atrial mitral regurgitation; ATR, atrial tricuspid regurgitation; AF, atrial fibrillation; HFpEF, heart failure with preserved ejection fraction; PH, pulmonary hypertension.