Cohort study
The Natural History of Atrial Functional Mitral Regurgitation
- Retrospective cohort study
- matched comparison for LVSD incidence
Authors' conclusion
In patients with predominantly mild-moderate/moderate AFMR, regression of MR was more common than progression, but neither was associated with mortality. Instead, diastolic function abnormalities were more important. Over a median 2-year follow-up, LVSD risk was not increased.
Study context
- Population
- Adults with left atrial (LA) volume index ≥40 mL/m², ≥mild-moderate atrial functional mitral regurgitation (AFMR) and follow-up echocardiogram96% mild-moderate/moderate AFMR
- Participants
- 635 adults
- Exposure
- ≥Mild-moderate AFMR vs no/mild AFMR
- AFMRn = 635
- Outcome
- Incident LV systolic dysfunction (EF <50% and ≥10% lower than baseline), AFMR progression to severe, persistent regression to no/trivial, and mortality
- Follow-up
- Median 2.2 years
Main finding
As reported in the abstract
Incidence rates per 100 person-years · median 2.2 years (Q1-Q3: 1.0-4.3 years)
| Group | LVSD | Progression of AFMR | Regression of AFMR |
|---|---|---|---|
| AFMR | 3.2 per 100 person-years | 1.9 per 100 person-years | 3.9 per 100 person-years |
- AFMR vs No/mild AFMR: P = 0.52 — LVSD incidence
Observational data: associations, not effects.
Further findings
Predictors of progression and regression
- Female sex and larger LA volume index independently associated with progression
- Younger age, male sex, absent AF and higher LA emptying fraction independently associated with regression
Independent risk factors for mortality
- Older age, concentric left ventricular (LV) geometry, higher estimated LV filling and pulmonary pressures
Original publication
The Natural History of Atrial Functional Mitral Regurgitation. J Am Coll Cardiol. Published 25 March 2024. doi:10.1016/j.jacc.2024.02.026
Summarised from the published abstract; every number is checked against it