Valvular & structural heart disease
Atrial Functional Mitral Regurgitation: Effect of Phenotype Definition on Classification, Valve Features, and Prognosis
Authors' conclusion
AfMR definitions show considerable variability in prevalence, valve features, and prognostic performance. Although the ESC guidelines and JACC Expert Consensus definitions yield similar prevalence, the JACC definition demonstrated robust prognostic validity and adaptability to a wider morphologic spectrum, including restrictive posterior leaflet (Carpentier IIIb) configurations.
Study context
- Population
- Patients with severe functional mitral regurgitation, independent single-centre database72 atrial functional mitral regurgitation (AfMR) definitions
- Comparison
- Published AfMR definitions applied to severe functional mitral regurgitation (fMR) vs moderate fMR
- Moderate fMRn = 6,755reference
- Outcome
- Mortality vs moderate fMR
Methodological detailssensitivity analyses
- Sensitivity analyses
Pooled result
As reported in the abstract
Each group vs moderate fMRHazard ratio (95% CI)P value
JACC
2.08(1.42–3.04)
P < 0.001ESC
1.88(1.26–2.82)
P = 0.002Further pooled results
Variability across 72 AfMR definitions
- Prevalence
- 2%-62%
- Annular diameter
- 31.5-37.1 mm
- Tenting area
- 146-229 mm²
- Carpentier IIIb
- 0%-49%
- Outcome HR
- 1.17-2.42
JACC vs European Society of Cardiology (ESC) definitions
- Left atrial threshold JACC
- 40 mL/m²
- Left atrial threshold ESC
- 34 mL/m²
- Carpentier IIIb cases included with JACC (ESC: type I only)
- 25%
- Similar overall prevalence but heterogeneous populations
Original publication
Atrial Functional Mitral Regurgitation: Effect of Phenotype Definition on Classification, Valve Features, and Prognosis. J Am Coll Cardiol. Published 18 March 2026. doi:10.
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