Atrial functional mitral regurgitation – current concepts in mechanisms, imaging, and management

Q: What is the clinical evidence from this study?

Study design: Review. Population: Atrial functional mitral regurgitation (AF-MR) in the context of heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation. Intervention: Stepwise integrated management (guideline-directed medical therapy for HFpEF, catheter ablation, mitral valve surgery, or transcatheter edge-to-edge repair).

Q: What does this research mean for the field?

Atrial functional mitral regurgitation is a distinct subtype of secondary mitral regurgitation driven by left atrial cardiomyopathy that requires management through heart failure with preserved ejection fraction therapy, rhythm control, and surgical or transcatheter repair. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marinka Peneva; Krasimir R. Dzhinsov; Tchavdar Nikolov Shalganov

doi:10.3897/bgcardio.32.e199974

October 30, 2026Bulgarian CardiologyOpen Access

Atrial functional mitral regurgitation – current concepts in mechanisms, imaging, and management

View Full Paper

Ask AI

Bookmark

Share

Key result

Atrial functional mitral regurgitation requires stepwise management spanning HFpEF therapy, rhythm control, and valve repair.

Why the study?

Atrial functional mitral regurgitation has emerged as a distinct subtype of secondary mitral regurgitation in patients with HFpEF and atrial fibrillation, with important pathophysiological, diagnostic, and treatment implications requiring synthesis of current knowledge.

Key Points

Summarize current concepts in the pathophysiology, imaging assessment, and therapeutic strategies for atrial functional mitral regurgitation as a distinct clinical entity.
Narrative review characterizing the mechanistic distinctions between atrial functional mitral regurgitation and ventricular functional mitral regurgitation.
Evaluation of diagnostic modalities, focusing on three-dimensional echocardiography and left atrial functional remodeling.
Review of multidisciplinary management strategies encompassing heart failure pharmacotherapy, catheter ablation, surgical annuloplasty, and transcatheter edge-to-edge repair.
Atrial functional mitral regurgitation arises from left atrial cardiomyopathy and annular dilation in the presence of preserved left ventricular systolic function.
Three-dimensional echocardiography characterizes annular flattening, posterior leaflet tethering, and coaptation loss to guide procedural interventions.
Therapeutic strategies targeting both rhythm control and mechanical leaflet coaptation, including transcatheter edge-to-edge repair and catheter ablation, represent key interventions to improve clinical outcomes.

Structured PICO

P

Population

Patients with atrial functional mitral regurgitation driven by left atrial cardiomyopathy in the setting of heart failure with preserved ejection fraction and atrial fibrillation.

I

Intervention

Integrated stepwise management including optimal guideline-directed medical therapy for HFpEF (diuretics, SGLT2 inhibitors such as empagliflozin and dapagliflozin), rhythm control strategies (catheter ablation, surgical ablation), mitral valve surgery (predominantly complete or posterior mitral annuloplasty, or replacement, with concomitant Maze, left atrial appendage occlusion, or tricuspid valve surgery), and transcatheter edge-to-edge repair (TEER).

Limitations

Lack of large randomized controlled trials directly comparing the effectiveness of medical, rhythm control, surgical, and transcatheter therapies alone or in combination
Unresolved criteria regarding optimal patient selection and timing of intervention
More detailed research in patient selection and timing of intervention is required to facilitate clinical outcomes.
Extensive research by RCT is required to compare the effectiveness of medical, ablation, and surgical or transcatheter methods, alone or in combination, to establish precise recommendations.
Improved characterization is necessary to differentiate between early-stage disease with prevalent annular dilatation and more advanced disease with atriogenic leaflet tethering.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This narrative review synthesizes current concepts on the pathophysiology, 3D echocardiographic assessment, and stepwise management of atrial functional mitral regurgitation, highlighting the integration of HFpEF medical therapy, rhythm control, and surgical or transcatheter valve interventions.

Abstract

Atrial functional mitral regurgitation (AF-MR) has emerged as a distinct subtype of secondary mitral regurgitation (MR) in the context of heart failure with preserved ejection fraction (HFpEF) and atrial ﬁ brillation, indicating advanced left atrial disease. This review outlines current knowledge in terms of pathophysiology, diagnosis, and therapy and highlights areas for further research. The differentiation between AF-MR and ventricular functional MR (VF-MR), primarily attributed to left ventricular (LV) remodeling, has important pathophysiological, diagnostic and treatment implications. Three-dimensional (3D) echocardiography and atrial function assessment have enabled detailed characterization of the underlying mechanism and guidance of treatment of AF-MR. Integrated therapeutic management ranges from optimal medical therapy for HFpEF, catheter ablation (CA), mitral valve annuloplasty or transcatheter edge-to-edge repair. AF-MR is a distinct disease with growing signiﬁcance driven by left atrial cardiomyopathy. The combination of advanced imaging, optimal medical therapy, and interventional strategies may improve prognosis. More detailed research in patient selection and timing of intervention is required to facilitate clinical outcomes.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Peneva et al. (2026) conducted a review in Atrial functional mitral regurgitation (AF-MR) in the context of heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation. Stepwise integrated management (guideline-directed medical therapy for HFpEF, catheter ablation, mitral valve surgery, or transcatheter edge-to-edge repair) was evaluated.

synapsesocial.com/papers/6ae682cae432e7a5c4ef375c https://doi.org/10.3897/bgcardio.32.e199974

View Full Paper

Ask AI

Bookmark

Share

Atrial functional mitral regurgitation – current concepts in mechanisms, imaging, and management

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Atrial functional mitral regurgitation – current concepts in mechanisms, imaging, and management

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading