Heart failure & cardiomyopathies
Atrial Functional Mitral Regurgitation and Exercise-Induced Changes in Heart Failure With Preserved Ejection Fraction
Authors' conclusion
AFMR is common in HFpEF and independently associated with adverse outcomes when moderate or severe at rest. Even mild, exercise-induced increases carry additional prognostic value
Study context
- Population
- Consecutive patients with heart failure with preserved ejection fraction (HFpEF) undergoing cardiopulmonary exercise testing with echocardiography
- Participants
- 429 patients
- Exposure
- Atrial functional mitral regurgitation (AFMR) severity at rest and exercise-induced mitral regurgitation (MR) increase
- Outcome
- CV hospitalizations and all-cause mortality
Methodological detailsmulticentre, consecutive patients
- Multicentre
- Consecutive patients
Main finding
As reported in the abstract
CV hospitalization and all-cause mortality
Hazard ratio (95% CI)P value
Moderate or severe MRat rest; adjusted for age, sex, ventricular and atrial volume and function
4.03(2.26–7.21)
P < 0.001Increase in effective regurgitant orifice area ≥5 mm² during exerciseabsolute increase; independently predictive, even without formal reclassification
2.43(1.34–4.41)
P = 0.004Observational data: associations, not effects.
Further findings
Correlates of AFMR severity
- Increasing AFMR severity correlated with AF, larger LA volumes, reduced LA function, lower peak oxygen consumption and more exercise-induced pulmonary hypertension
- Exercise EROA increase not related to systemic BP, chronotropic incompetence or LV dysfunction
Original publication
Atrial Functional Mitral Regurgitation and Exercise-Induced Changes in Heart Failure With Preserved Ejection Fraction. JACC Cardiovasc Imaging. Published 8 September 2025. doi:10.
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