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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
Published on: May 19, 2020
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Atrial functional mitral regurgitation: definition, features, and unknowns.
Frank A Flachskampf1,2, Ruxandra Beyer3, Wolfgang Fehske4
1Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden. frank.flachskampf@medsci.uu.se.
Summary
Atrial functional mitral regurgitation (AFMR) stems from atrial enlargement, not ventricular issues, often linked to atrial fibrillation. This condition may be underestimated in heart failure patients due to overlapping symptoms.
Area of Science:
- Cardiology
- Cardiac Surgery
- Heart Valve Disease
Background:
- Atrial functional mitral regurgitation (AFMR) is an underrecognized condition.
- It is driven by atrial dilatation, commonly from persistent atrial fibrillation.
- AFMR often coexists with diastolic dysfunction and heart failure with preserved ejection fraction.
Purpose of the Study:
- To review current understanding and insights into AFMR.
- To highlight the role of atrial changes in mitral regurgitation.
- To clarify the relationship between AFMR, atrial fibrillation, and heart failure.
Main Methods:
- Literature review of published studies on AFMR.
- Analysis of mechanisms involving atrial annular dilatation and leaflet coaptation.
- Comparison of AFMR characteristics with heart failure with preserved ejection fraction.
Main Results:
- AFMR results from increased mitral annular area, causing poor leaflet closure.
- The left ventricle is typically normal in size and function.
- Regurgitation severity is usually moderate or moderate-to-severe by standard metrics.
Conclusions:
- AFMR is primarily caused by atrial, not ventricular, enlargement.
- The overlap in symptoms with heart failure with preserved ejection fraction suggests AFMR's role may be underestimated.
- Further elucidation of AFMR's time course and symptomatic impact is needed.
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