Heart failure & cardiomyopathiesCohort study
Atrial Functional Mitral Regurgitation and Exercise-Induced Changes in Heart Failure With Preserved Ejection Fraction
- Prospective cohort study
- multicentre
- consecutive patients
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
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:10.1016/j.jcmg.2025.07.016
Summarised from the published abstract; every number is checked against it