TY - JOUR
T1 - The Natural History of Atrial Functional Mitral Regurgitation
AU - Naser, Jwan A.
AU - Alexandrino, Francisco B.
AU - Harada, Tomonari
AU - Michelena, Hector I.
AU - Borlaug, Barry A.
AU - Eleid, Mackram F.
AU - Lin, Grace
AU - Scott, Christopher
AU - Kennedy, Austin M.
AU - Pellikka, Patricia A.
AU - Nkomo, Vuyisile T.
AU - Pislaru, Sorin V.
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/4/23
Y1 - 2024/4/23
N2 - Background: The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown. Objectives: The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality. Methods: Adults with left atrial (LA) volume index ≥40 mL/m2, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial. Relation of AFMR progression or regression as time-dependent covariates with all-cause mortality was studied. Incidence of LVSD was compared with patients with no/mild AFMR matched on age, sex, comorbidities and ejection fraction. Patients were followed until mitral intervention, myocardial infarction, or last follow-up. Results: A total of 635 patients (median age 75 years, 51% female, 96% mild-moderate/moderate AFMR, 4% severe AFMR) were included. Over a median 2.2 years (Q1-Q3: 1.0-4.3 years), incidence rates per 100 person-years were 3.2 for LVSD (P = 0.52 vs patients with no/mild AFMR), 1.9 for progression of AFMR, and 3.9 for regression. Female sex and larger LA volume index were independently associated with progression, whereas younger age, male sex, absent atrial fibrillation, and higher LA emptying fraction were independently associated with regression. Neither AFMR progression nor regression was independently associated with mortality. Instead, independent risk factors for mortality included older age, concentric LV geometry, and higher estimated LV filling and pulmonary pressures. Conclusions: In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
AB - Background: The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown. Objectives: The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality. Methods: Adults with left atrial (LA) volume index ≥40 mL/m2, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial. Relation of AFMR progression or regression as time-dependent covariates with all-cause mortality was studied. Incidence of LVSD was compared with patients with no/mild AFMR matched on age, sex, comorbidities and ejection fraction. Patients were followed until mitral intervention, myocardial infarction, or last follow-up. Results: A total of 635 patients (median age 75 years, 51% female, 96% mild-moderate/moderate AFMR, 4% severe AFMR) were included. Over a median 2.2 years (Q1-Q3: 1.0-4.3 years), incidence rates per 100 person-years were 3.2 for LVSD (P = 0.52 vs patients with no/mild AFMR), 1.9 for progression of AFMR, and 3.9 for regression. Female sex and larger LA volume index were independently associated with progression, whereas younger age, male sex, absent atrial fibrillation, and higher LA emptying fraction were independently associated with regression. Neither AFMR progression nor regression was independently associated with mortality. Instead, independent risk factors for mortality included older age, concentric LV geometry, and higher estimated LV filling and pulmonary pressures. Conclusions: In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
KW - atrial myopathy
KW - diastolic dysfunction
KW - echocardiography
KW - mitral regurgitation
KW - rhythm control
KW - systolic dysfunction
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U2 - 10.1016/j.jacc.2024.02.026
DO - 10.1016/j.jacc.2024.02.026
M3 - Article
C2 - 38530687
AN - SCOPUS:85189372644
SN - 0735-1097
VL - 83
SP - 1495
EP - 1507
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -