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      Etiology of Atrial Functional Mitral Regurgitation: Insights from Transthoracic Echocardiography in 159 Consecutive Patients with Atrial Fibrillation and Preserved Left Ventricular Ejection Fraction

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          Background: Left atrial (LA) dilatation in patients with atrial fibrillation (AF) can induce functional mitral regurgitation (MR) despite a preserved left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the etiology of this functional MR. Methods: We retrospectively examined clinical and echocardiographic data from 5,202 consecutive cases that underwent transthoracic echocardiography. AF appeared in 544 patients, and we selected 159 with AF and LVEF ≥50% after excluding patients with other underlying heart diseases. Results: Significant (moderate or greater) degrees of functional MR were seen in 13 (8.2%) patients and were more frequently seen in patients with an AF duration of >10 years than in others (27 vs. 4%, p = 0.0057). Multiple regression analysis revealed that both the LA dimension index and the left ventricular (LV) systolic dimension index were independent determinants of the MR grading. Among the mitral morphologic parameters, the mitral annular (MA) dimension index and the hamstringing phenomenon of the posterior mitral leaflet were independent determinants of MR grading. Significant MR was not seen in patients without LA dilatations, but it occurred in 14% of patients with LA dilatation alone and in 55% with both LA and LV dilatations; the MA dimension index increased in this order. Conclusions: The grading of functional MR occurring in patients with AF and preserved LVEF depends on both the LA dimension and the LV systolic dimension. The MR grading also depends on both the MA dilatation and the hamstringing phenomenon of the posterior mitral leaflet.

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          Most cited references 18

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          Cardiac valve surgery—the “French correction”

            • Record: found
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            Task force 4: training in echocardiography endorsed by the American Society of Echocardiography.

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              Insufficient Leaflet Remodeling in Patients With Atrial FibrillationCLINICAL PERSPECTIVE

              The relationship between annular dilatation caused by atrial fibrillation (AF) and mitral regurgitation (MR) remains controversial. We hypothesized that the small ratio of total leaflet area/annulus area (TLA/AA), reflecting insufficient leaflet remodeling to annular dilatation, is a main component of MR in patients with AF.

                Author and article information

                S. Karger AG
                August 2020
                15 June 2020
                : 145
                : 8
                : 511-521
                aDepartment of Cardiology, Osaka City General Hospital, Osaka, Japan
                bDepartment of Cardiovascular Surgery, Osaka City University, Osaka, Japan
                cDepartment of Cardiology, Osaka City University, Osaka, Japan
                Author notes
                *Yukio Abe, MD, PhD, Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021 (Japan), abeyukio@aol.com
                508279 Cardiology 2020;145:511–521
                © 2020 S. Karger AG, Basel

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                Page count
                Figures: 5, Tables: 5, Pages: 11
                Valvular Heart Disease: Research Article


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