https://orcid.org/0000-0003-4549-7770
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Kentaro Minami, Kimi Sato, Tomoko Machino-Ohtsuka, Nobuyuki Kagiyama, Comparison of clinical characteristics and prognosis of patients with atrial functional mitral regurgitation exhibiting sinus rhythm and atrial fibrillation, European Heart Journal - Cardiovascular Imaging, Volume 26, Issue 5, May 2025, Pages 928–930, https://doi.org/10.1093/ehjci/jeaf061
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Atrial functional mitral regurgitation (AFMR) is a subset of functional mitral regurgitation (MR) observed in patients without left ventricular (LV) dysfunction. AFMR is associated with adverse left atrial (LA) remodelling. Although AFMR commonly occurs in patients with a history of atrial fibrillation (AF),1,2 it is observed in patients with sinus rhythm (SR),3 and the mechanism and clinical presentation of AFMR, especially the interplay between cardiac rhythms and AFMR, are poorly defined. Therefore, we aimed to investigate the differences in clinical characteristics and outcomes of patients with AFMR with SR and those with AF.
This study was a post hoc analysis of a multicentre retrospective registry (the Real-World Observational Study for Investigating the Prevalence and Therapeutic Options for Atrial Functional Mitral Regurgitation: REVEAL-AFMR),4 and included 1007 patients with moderate or severe AFMR (mean age 78 years, 56% female patients). Patients were divided into three groups according to cardiac rhythm: SR (AFMRSR), paroxysmal AF (AFMRpAF), and non-paroxysmal AF (AFMRnon-pAF). Clinical and echocardiographic features, as well as prognosis, were compared. AFMRSR comprised patients with no evidence of AF at baseline or on previous ECGs and no history of catheter ablation for AF. Non-pAF included persistent AF (AF lasting >7 days) and permanent AF (continuous AF lasting ≥1 year). The primary endpoint was a composite of all-cause death and hospitalization for heart failure (HF). The secondary endpoint was cardiac intervention, defined as a composite of cardiac surgery, transcatheter edge-to-edge repair of the mitral valve (M-TEER), transcatheter aortic valve implantation (TAVI), and pulmonary vein isolation (PVI) for AF. We also analysed mitral valve (MV) interventions, including MV repair/replacement and M-TEER, as secondary endpoints. Cox proportional hazard regression models were used to evaluate the influence of cardiac rhythm type on clinical outcomes. A multivariable model was constructed adjusting for age, sex, body mass index, systolic blood pressure, New York Heart Association class III or IV, hospitalization for HF, haemoglobin, creatinine, EuroSCORE II, and cardiac rhythm. A competing risk regression analysis was also performed using the Fine–Gray proportional sub-hazards model, considering the possibility of competing risks between the primary endpoint and cardiac interventions.
