Atrial Functional Mitral Regurgitation: A JACC: Cardiovascular Imaging Expert Panel Viewpoint.

Functional or secondary mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality. Mechanistically, secondary MR is attributable to an imbalance between mitral leaflet tethering and closure forces, leading to poor coaptation. The pathophysiology of functional MR is most often the result of abnormalities in left ventricular function and remodeling, seen in ischemic or nonischemic conditions. Less commonly and more recently recognized is the scenario in which left ventricular geometry and function are preserved, the culprit being mitral annular enlargement associated with left atrial dilatation, termed atrial functional mitral regurgitation (AFMR). This most commonly occurs in the setting of chronic atrial fibrillation or heart failure with preserved ejection fraction. There is variability in the published reports and in current investigations as to the definition of AFMR. This paper reviews the pathophysiology of AFMR and focus on the need for a collective definition of AFMR to facilitate consistency in reported data and enhance much-needed research into outcomes and treatment strategies in AFMR.

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Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Funding Support and Author Disclosures Dr Levine was supported in part by a National Institute of Health grant (R01 HL141917) and by a American Heart Association grant (#963793/Levine/2022). Dr Grayburn has received research grants from Abbott Vascular, Boston Scientific, Cardiovalve, Edwards Lifesciences, Medtronic, Neochord, W.L. Gore, and 4C Medical; and he was a consultant/advisory board member for Abbott Vascular, Edwards Lifesciences, Medtronic, W.L. Gore, and 4C Medical. Dr Leipsic holds institutional CT core laboratory contracts for which he takes no compensation with Edwards Lifesciences, Abbott, Medtronic, Boston Scientific, and Neovasc; and he serves as a consultant to Circle CVI. Dr Thomas has received research grants and honoraria from GE Medical; research grants and consulting fees from Abbott Vascular; and research grants and honoraria from Edwards. Dr Gillam is an advisor for Bracco, Philips, and Edwards Lifesciences; and has Core Lab Contracts (no direct compensation) with Medtronic and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.