Atrial Functional Mitral Regurgitation

Atrial Functional Mitral Regurgitation(JACC Review Topic of the Week May 2019)

(i) Functional MR is the result of an imbalance between increased tethering forces (due to global and/or focal LV dilation, papillary muscle displacement and/or dysfunction) and decreased closing forces (reduced LV contractility and/or synchronicity) in the presence of a structurally normal valve.

(ii)Annular dimensions (tethering) and dynamics (closing) contribute to this imbalance in ischemic or dilated cardiomyopathy, although concomitant subvalvular tethering is typically needed to cause more than moderate (ventricular) functional MR

(iii) Atrial functional MR typically occurs in the context of AF and/or HFpEF.

(iv)Isolated annular dilation, insufficient leaflet growth, and impaired annular dynamics are mechanical culprits.

(v) Secondary MR vs Atrial Functional MR

(vi) Pathophysiology of Atrial Functional MR

(vii) Echocardiography Diagnosis