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Review
. 2022 Dec 13;80(24):2314-2330.
doi: 10.1016/j.jacc.2022.09.046.

Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review

Serdar Farhan  1 , Jeffrey J Silbiger  2 , Jonathan L Halperin  1 , Lily Zhang  1 , Srinivas R Dukkipati  1 , Birgit Vogel  1 , Annapoorna Kini  1 , Samin Sharma  1 , Stamatios Lerakis  3
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Free article
Review

Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation: JACC State-of-the-Art Review

Serdar Farhan et al. J Am Coll Cardiol. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Coll Cardiol. 2023 Feb 21;81(7):711. doi: 10.1016/j.jacc.2023.01.003. J Am Coll Cardiol. 2023. PMID: 36792288 No abstract available.

Abstract

The conventional view holds that functional mitral regurgitation (MR) is caused by restriction of leaflet motion resulting from displacement of the papillary muscle-bearing segments of the left ventricle. In the past decade, evidence has accrued suggesting functional MR can also be caused by left atrial enlargement. This underrecognized cause of secondary MR-atrial functional MR (AF-MR)-is mechanistically linked to annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering. AF-MR has been described in patients with atrial fibrillation and heart failure with preserved ejection fraction. Preliminary data suggest rhythm control may decrease MR severity in patients with atrial fibrillation. Additionally, several studies have reported reductions in MR and symptomatic improvement with restrictive annuloplasty and transcatheter edge-to-edge repair. This review discusses the pathophysiology, echocardiographic diagnosis, and treatment of AF-MR. AF-tricuspid regurgitation is also discussed.

Keywords: atrial fibrillation; atrial functional mitral regurgitation; atrial functional tricuspid regurgitation; atriogenic leaflet tethering; hamstringing; mitral annulus.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Silbiger has served on the speakers’ bureau of Lantheus Medical Imaging. Dr Halperin has served as a consultant for Abbott Laboratories, Anthos Therapeutics, and Bayer AG Healthcare. Dr Dukkipati holds equity in Manual Surgical Sciences and Farapulse, which has been acquired by Boston Scientific Corporation. Dr Sharma has served on the speakers’ bureau of Abbott Laboratories, Boston Scientific Corporation, and Cardiovascular Systems Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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