Impaired mitral annulus dynamics are responsible for Atrial functional MR finds JACC study.
Atrial functional mitral regurgitation (AFMR) is a relatively new entity that describes mitral regurgitation (MR) in the setting of normal left ventricular function, structurally normal leaflets, and mitral annular dilation, which is encountered in patients with atrial fibrillation and/or heart failure with preserved ejection fraction (HFpEF). The mechanisms underlying this entity are still poorly described although a role of annular dilatation has been suggested.
In the latest issue of JACC Cardiovascular Imaging, Deferm et al provide evidence that annular dynamics play a crucial role in the pathophysiology of AFMR besides annular dilation. Authors found that AF related blunted presystolic narrowing contributes to AFMR and sinus rhythm restoration allows gradual recovery of presystolic annular dynamics.
Fifty-three patients with persistent AF and normal left ventricular ejection fraction were prospectively examined by echocardiography before, immediately after, and 6 weeks after electric cardioversion to sinus rhythm. Annular motion was assessed during AF and in sinus rhythm with the use of 3-dimensional analysis software, and the relationship with MR severity was explored.
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