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Updated: Jan 12, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Mitral Regurgitation and the Risk of Stroke among Patients with Atrial Fibrillation and Heart Failure
Anat Berkovitch1, Michael Arad1, Israel Mazin1
1Department of Cardiology, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Background:
Significant mitral regurgitation (MR) is associated with less spontaneous echo contrast but its effect on the occurrence of ischemic stroke in patients with atrial fibrillation (AF) is unknown.
Objectives:
To examine the association of MR grade and the risk of ischemic stroke (IS) in AF patients with heart failure (HF).
Methods:
We investigated 2748 patients with known AF who were hospitalized due to acute decompensated HF. All patients underwent echocardiography during hospitalization. Patients were divided into groups based on the degree of MR (high-grade MR [3-4] vs. no/low-grade MR [0-2]). The primary endpoint was IS during long term follow-up.
Results:
Mean age was 79 ± 11 years, 48% were women. After 2 years of follow-up, the cumulative incidence of IS among patients with high-grade MR was significantly lower compared to patients with no/low-grade MR (6% vs. 12%, respectively; P-value = 0.0064). Multivariate Fine and Gray analysis, adjusting for CHA₂DS₂-VASc, and accounting for the competing risk of death and valve intervention, showed the presence of high-grade MR was associated with a significant 50% (P = 0.013) reduction in the risk of IS compared with no/low-grade MR. When added to the CHA₂DS₂-VASc score, MR grade allowed more accurate prediction of IS with an overall improvement of 12% (95% confidence interval 5-17%) using net reclassification index analysis.
Conclusions:
Our findings suggest an inverse correlation between MR grade and the risk of stroke among AF patients with HF. These findings may be used for improved risk assessment in this population.
Insights
High-grade mitral regurgitation (MR) is linked to a lower risk of ischemic stroke (IS) in patients with atrial fibrillation (AF) and heart failure (HF). This finding may improve stroke risk assessment in this patient group.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Significant mitral regurgitation (MR) is known to reduce spontaneous echo contrast.
- The impact of MR on ischemic stroke (IS) risk in atrial fibrillation (AF) patients remains unclear.
Purpose of the Study:
- To investigate the association between the grade of MR and the risk of IS.
- To assess the predictive value of MR in AF patients experiencing heart failure (HF).
Main Methods:
- A cohort of 2748 AF patients hospitalized for acute decompensated HF was studied.
- Echocardiography was performed to categorize MR severity (high-grade vs. no/low-grade).
- Long-term follow-up data were analyzed for the primary endpoint of IS, using Fine and Gray multivariate analysis.
Main Results:
- Patients with high-grade MR had a significantly lower cumulative incidence of IS (6% vs. 12%) after 2 years.
- High-grade MR was associated with a 50% reduction in IS risk, independent of CHA₂DS₂-VASc score.
- Incorporating MR grade improved IS prediction accuracy by 12% (95% CI 5-17%).
Conclusions:
- An inverse correlation exists between MR grade and stroke risk in AF patients with HF.
- MR grade can enhance the risk stratification of IS in this population.
- Findings support using MR assessment for improved clinical decision-making.
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