Maintenance of sinus rhythm after cardioversion was independently associated with significant improvement in mitral regurgitation severity compared to recurrent AF (32.4% vs 19.0%; OR 1.9, p=0.007).
Cohort (n=446)
Does maintenance of sinus rhythm after cardioversion improve mitral regurgitation severity in patients with significant mitral regurgitation and atrial fibrillation?
Maintenance of sinus rhythm after cardioversion in patients with atrial fibrillation and significant mitral regurgitation independently predicts a significant reduction in MR severity and improvement in left ventricular dimensions.
Odds Ratio: 1.9
Absolute Event Rate: 32.4% vs 19%
p-value: p=0.007
Background: Presently there is limited data on the effect of atrial fibrillation (AF) on the severity of mitral regurgitation (MR). Objective: To determine whether in patients with significant MR, conversion of AF to sinus rhythm might reduce the severity of MR. Methods: Between 1992-2011, 446 patients (52% females, mean age 74.0+12.3 yrs) with significant MR and AF underwent cardioversion to sinus rhythm. All had follow up echocardiography within 6 months. We compared the severity of MR during AF to that during sinus rhythm. Improvement was regarded if MR was reduced by at least 2 grades. MR severity was graded as 1-no or minimal, 2-mild, 3-moderate, 4-severe. Results: After 6 months, 278 (62.3%) patients remained in sinus rhythm (group 1) and 168 (37.7%) were in AF (group 2). There was no difference between the groups with regard to hypertension, diabetes, stable or unstable coronary artery disease. In 122 (27.4%) patients, MR severity improved by more than two grades and it was more pronounced in males 32.5% vs females 22.6% (p=0.019). Significant MR improvement was seen in group 1 compared to group 2 (32.4%vs 19%, p=0.002). Left ventricular diameter improved significantly (left ventricular end diastolic (LVEDD) from 5.13 cm to 4.98cm, p=0.036, left ventricular end systolic (LVESD) from 3.62cm to 3.40cm, p=0.0314) compared to group 2 (LVEDD 5.18 cm to 5.25cm, p=0.3410, LVESD 3.69cm to 3.71cm, p=0.2995). Univariate analysis revealed sinus rhythm (OR 1.73, p=0.024), male gender (OR 1.55, p=0.046) and time interval between echo test less than 42 days (OR 1.52, p=0.059) were predictors for significant MR improvement. Multivariate analysis revealed sinus rhythm remained an independent factor for significant MR improvement (OR 1.9, p=0.007). Conclusions: In 27% of patients with paroxysmal AF, MR improves significantly after cardioversion to sinus rhythm. Final assessment of MR severity should be based on echocardiographic data when the patient is in sinus rhythm.
Mtour et al. (Fri,) conducted a cohort in significant mitral regurgitation and atrial fibrillation (n=446). Maintenance of sinus rhythm vs. Recurrent atrial fibrillation was evaluated on Improvement in mitral regurgitation severity by at least 2 grades (OR 1.9, p=0.007). Maintenance of sinus rhythm after cardioversion was independently associated with significant improvement in mitral regurgitation severity compared to recurrent AF (32.4% vs 19.0%; OR 1.9, p=0.007).
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