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. 2023 Mar 8;10(1):4.
doi: 10.1186/s44156-023-00015-y.

Atrial secondary mitral regurgitation: prevalence, characteristics, management, and long-term outcomes

Sam Straw  1   2 , Ankit Gupta  1 , Kerryanne Johnson  3 , Charlotte A Cole  2 , Kinan Kneizeh  4 , John Gierula  1   2 , Mark T Kearney  1 , Christopher J Malkin  2 , Maria F Paton  1   2 , Klaus K Witte  5   6 , Dominik Schlosshan  2
Affiliations

Atrial secondary mitral regurgitation: prevalence, characteristics, management, and long-term outcomes

Sam Straw et al. Echo Res Pract. .

Abstract

Background: The prevalence, clinical characteristics, management and long-term outcomes of patients with atrial secondary mitral regurgitation (ASMR) are not well described.

Methods: We performed a retrospective, observational study of consecutive patients with grade III/IV MR determined by transthoracic echocardiography. The aetiology of MR was grouped as being either primary (due to degenerative mitral valve disease), ventricular SMR (VSMR: due to left ventricular dilatation/dysfunction), ASMR (due to LA dilatation), or other.

Results: A total of 388 individuals were identified who had grade III/IV MR; of whom 37 (9.5%) had ASMR, 113 (29.1%) had VSMR, 193 had primary MR (49.7%), and 45 (11.6%) were classified as having other causes. Compared to MR of other subtypes, patients with ASMR were on average older (median age 82 [74-87] years, p < 0.001), were more likely to be female (67.6%, p = 0.004) and usually had atrial fibrillation (83.8%, p = 0.001). All-cause mortality was highest in patients with ASMR (p < 0.001), but similar to that in patients with VSMR once adjusted for age and sex (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.52-1.25). Hospitalisation for worsening heart failure was more commonly observed in those with ASMR or VSMR (p < 0.001) although was similar between these groups when age and sex were accounted for (HR 0.74, 95% CI 0.34-1.58). For patients with ASMR, the only variables associated with outcomes were age and co-morbidities.

Conclusions: ASMR is a prevalent and distinct disease process associated with a poor prognosis, with much of this related to older age and co-morbidities.

Keywords: Atrial fibrillation; Heart failure; Mitral regurgitation; Secondary mitral regurgitation; Valvular heart disease.

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Conflict of interest statement

SS is supported by the British Heart Foundation. KJ is supported by the New Zealand Heart Foundation. JG is supported by the National Institute of Health Research. CAC is supported by the Leeds Hospitals Charity. SS has received speaker’s fees and honoraria from AstraZeneca. KKW has received speaker’s fees and honoraria from Medtronic, Cardiac Dimensions, Novartis, Abbott, BMS, Pfizer, Bayer and has received an unconditional research grant from Medtronic. JG has received speaker’s fees and honoraria from Abbott, Medtronic and Microport and has received an unrestricted research grant from Medtronic. None of the other authors have conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Kaplan–Meier plots of all-cause mortality and heart failure hospitalisation divided by aetiology of mitral regurgitation
See this image and copyright information in PMC

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