Atrial functional mitral regurgitation, caused by mitral annular enlargement and left atrial dilatation, requires a standardized definition to improve research consistency and treatment strategies.
Functional or secondary mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality. Mechanistically, secondary MR is attributable to an imbalance between mitral leaflet tethering and closure forces, leading to poor coaptation. The pathophysiology of functional MR is most often the result of abnormalities in left ventricular function and remodeling, seen in ischemic or nonischemic conditions. Less commonly and more recently recognized is the scenario in which left ventricular geometry and function are preserved, the culprit being mitral annular enlargement associated with left atrial dilatation, termed atrial functional mitral regurgitation (AFMR). This most commonly occurs in the setting of chronic atrial fibrillation or heart failure with preserved ejection fraction. There is variability in the published reports and in current investigations as to the definition of AFMR. This paper reviews the pathophysiology of AFMR and focus on the need for a collective definition of AFMR to facilitate consistency in reported data and enhance much-needed research into outcomes and treatment strategies in AFMR.
“Atrial FMR is increasingly recognized as an important consequence of chronic atrial fibrillation. It's a challenging problem. It tends to affect older patients. It tends to contribute to heart failure development, often in the setting of preserved ejection fraction. And it's a context in which we don't often have very effective or targeted medical therapy.”
William A. Zoghbi (Tue,) conducted a review in Atrial functional mitral regurgitation. Atrial functional mitral regurgitation, caused by mitral annular enlargement and left atrial dilatation, requires a standardized definition to improve research consistency and treatment strategies.