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Atrial functional mitral regurgitation: Insufficiently understood and recognized
1Department of Clinical Physiology and Cardiology, Uppsala University Hospital, Sweden.
Summary
Atrial functional mitral regurgitation (AFMR) stems from atrial enlargement, not ventricular issues, often linked to atrial fibrillation. This review clarifies AFMR mechanisms and characteristics.
Area of Science:
- Cardiology
- Cardiac Physiology
Background:
- Atrial functional mitral regurgitation (AFMR) is an under-recognized condition.
- It is primarily caused by atrial dilatation, often secondary to chronic atrial fibrillation.
- AFMR frequently coexists with left ventricular diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF).
Discussion:
- Atrial enlargement increases mitral annular area, impairing leaflet coaptation and causing annular flattening and reduced contraction.
- The left ventricle (LV) typically remains normal in size with preserved function, leading to central regurgitant jets.
- A variant involves posterior leaflet tethering and localized annular dilatation, with regurgitation usually moderate or moderate-to-severe.
Key Insights:
- AFMR pathogenesis is driven by atrial, not ventricular, remodeling.
- Normal LV size and function are characteristic, distinguishing it from ventricular functional MR.
- Understanding AFMR is crucial for managing HFpEF patients.
Outlook:
- Further research is needed to clarify the time course of AFMR progression.
- The relationship between AFMR, LV remodeling, and clinical symptoms requires elucidation.
- This review consolidates current knowledge on AFMR for clinical and research communities.
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