Atrial functional versus ventricular functional mitral regurgitation: Prognostic implications

Hirji, Sameer; Côté, Claudia L.; Javadikasgari, Hoda; Malarczyk, Alexandra; McGurk, Siobhan; Kaneko, Tsuyoshi

doi:10.1016/j.jtcvs.2020.12.098

Cited by 27 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Two groups reported proportions of patients whose MV was eventually considered not repairable and was, therefore, replaced (13.8% 21 and 27.3% 14 ).…”

Section: Resultsmentioning

confidence: 99%

“…First, atriogenic leaflet tethering is usually mild in AFMR, and it does not typically lead to the easily recognizable “seagull sign” with a LA‐facing concavity 29 . Second, thickened leaflets secondary to EMT tend to rest in the plane of the annulus, generally causing a centrally directed jet, 30 and this was considered an inclusion criterion only by one study 21 ; conversely, it has been reported that AFMR cases with predominant restriction of the posteromedial papillary muscle usually present a posteriorly directed jet, 31 thus suggesting that neither features represent specific findings in AFMR.…”

Section: Discussionmentioning

confidence: 99%

“…Vohra et al 15 Takahashi et al 16 Takahashi et al 17 Sakaguchi et al 7 Kaneyuki et al 18 Chen et al 19 Matsumori et al 14 Balogh et al 20 Tanaka et al 13 Hirji et al 21 Carino et al 22 Inclusion criteria Chronic AF Carpentier Type 2…”

Section: Definition Of Afmr: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…In addition to correcting the dilatation of the mitral annulus, four groups performed concomitant neochordoplasty in selected patients (13.3%-55%), 6,14,16,17 and one group performed concomitant posterior leaflet extension with autologous pericardium in a proportion of patients (24.4%). 17 Two groups reported proportions of patients whose MV was eventually considered not repairable and was, therefore, replaced (13.8% 21 ablation in 100% of patients and the remaining studies leaving a median of 50% patients surgically untreated for AF (range 20.5%-82.2%) (Figure 2A). In addition, LA appendage ligation was consistently performed in three studies, never performed in four studies, and variably performed in the remaining studies (Figure 2B).…”

Section: Variability In the Treatment Of Afmr Valvulopathiesmentioning

confidence: 99%

See 3 more Smart Citations

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

Amabile

Fereydooni

Mori

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Objectives Atrial functional mitral regurgitation (AFMR) is a subtype of functional mitral regurgitation due to longstanding atrial fibrillation (AF) or heart failure with preserved ejection fraction. The variation in AFMR' definition and the common mode of treatment described in the literature remain unknown. Methods We performed a scoping review of studies that surgically treated AFMR to characterize the existing variability in the definition of AFMR, the type of operations performed for AFMR valvulopathy, and the treatment for the chronic AF. We searched Medline, EMBASE, Cochrane Library, Scopus, and Web of Science since their inceptions for studies of patients affected by AFMR and surgically treated for their valvulopathy. Results Twelve studies (n = 494 patients) met eligibility criteria. All studies excluded patients with signs of left ventricular (LV) dysfunction, but the way additional parameters were used to define AFMR at a more granular level varied across studies: nine studies (75%) used the presence of AF to define their AFMR cohorts, with five (41.2%) requiring a history of AF of >1 year; additionally, the threshold values for the LV ejection fraction differed (45%–55%). Isolated mitral annuloplasty was performed in 96.2% of patients. Broad variability was detected in the proportion of patients undergoing the Cox‐Maze procedure (range, 17.8%–79.5%), pulmonary vein isolation (0.0%–66.7%), and left atrial appendage ligation (0.0%–100.0%). Conclusions AFMR remains variably defined in surgical studies, making comparisons across studies difficult. Mitral annuloplasty was most commonly performed. The proportion of AFMR patients undergoing concomitant procedures for AF varied substantially.

show abstract

“…Two groups reported proportions of patients whose MV was eventually considered not repairable and was, therefore, replaced (13.8% 21 and 27.3% 14 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Definition Of Afmr: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Section: Variability In the Treatment Of Afmr Valvulopathiesmentioning

confidence: 99%

See 2 more Smart Citations

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

Amabile

Fereydooni

Mori

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…This contrasts the SMR of ventricular etiology commonly seen in ischemic cardiomyopathy and dilated cardiomyopathy. While the different etiologies and potentially effective treatments are recognized between the two subtypes of SMR [ 3 , 4 ], the natural history of patients with different severities of SMR related to atrial dysfunction has not been well described beyond small single-center series [ 5 , 6 ]. Understanding the difference in survival between comparable severities of SMR in atrial versus ventricular dysfunction may further inform the timing of surveillance and potential therapeutic options [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction

et al. 2022

View full text Add to dashboard Cite

Background Natural history of atrial and ventricular secondary mitral regurgitation (SMR) is poorly understood. We compared the impact of the degree of SMR on survival between atrial and ventricular dysfunction. Methods We conducted a retrospective cohort study of patients who underwent echocardiography in a healthcare network between 2013–2018. We compared the survival of patients with atrial and ventricular dysfunction, using propensity scores developed from differences in patient demographics and comorbidities within SMR severity strata (none, mild, moderate or severe). We fitted Cox proportional hazards models to estimate the risk-adjusted hazards of death across different severities of SMR between patients with atrial and ventricular dysfunction. Results Of 11,987 patients included (median age 69 years [IQR 58–80]; 46% women), 6,254 (52%) had isolated atrial dysfunction, and 5,733 (48%) had ventricular dysfunction. 3,522 patients were matched from each arm using coarsened exact matching. Hazard of death in atrial dysfunction without SMR was comparable to ventricular dysfunction without SMR (HR 1.1, 95% CI 0.9–1.3). Using ventricular dysfunction without SMR as reference, hazards of death remained higher in ventricular dysfunction than in atrial dysfunction across increasing severities of SMR: mild SMR (HR 2.1, 95% CI 1.8–2.4 in ventricular dysfunction versus HR 1.7, 95%CI 1.5–2.0 in atrial dysfunction) and moderate/severe SMR (HR 2.8, 95%CI 2.4–3.4 versus HR 2.4, 95%CI 2.0–2.9). Conclusions SMR across all severities were associated with better survival in atrial dysfunction than in ventricular dysfunction, though the magnitude of the diminishing survival were similar between atrial and ventricular dysfunction in increasing severity of SMRs.

show abstract

Outcomes of transcatheter edge‐to‐edge repair for atrial functional mitral regurgitation: A meta‐analysis of observational studies

Hamada,

Ueyama,

Aikawa

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

BackgroundTranscatheter edge‐to‐edge repair (TEER) may have potential benefits in the treatment of atrial functional mitral regurgitation (AFMR), but robust evidence is currently lacking. We conducted a systematic review and meta‐analysis to investigate the clinical outcomes of TEER for AFMR, including comparisons to ventricular functional MR (VFMR).MethodsMEDLINE and EMBASE were searched through January 2023 to identify studies eligible for analysis. The primary outcome was postprocedural MR severity. Postprocedural New York Heart Association (NYHA) functional class classification and all‐cause mortality were also evaluated. Outcomes were stratified into short term (postprocedure to 6 months) and long term (6 months to 2 years).ResultsA total of eight observational studies met the inclusion criteria, enrolling 539 AFMR and 3486 VFMR patients. Postprocedural MR grade ≤2 in the AFMR group was observed in 93.7% (454/491 patients; 95% confidence interval (CI), 91.1%–96.2%, I2 = 24.3%) and 97.1% (89/93 patients; 95% CI, 92.9%–100%, I2 = 26.4%) in short‐ and long‐term follow‐up, respectively. There was no difference in the rates of postprocedural MR grade ≤2 between AFMR and VFMR either in short‐term (risk ratio [RR], 1.00 [95% CI, 0.95–1.06]; p = 0.90; I2 = 53%) or long‐term follow‐up (RR, 1.08 [95% CI, 0.89–1.32]; p = 0.44; I2 = 22%). Similarly, no difference was observed between AFMR and VFMR in the rates of postprocedural NYHA class ≤2 or all‐cause mortality.ConclusionTEER provides similar clinical outcomes for AFMR and VFMR. A high rate of MR grade ≤2 was observed in patients at both short‐ and long‐term follow‐ups. Further prospective studies with TEER versus medical therapy and/or rhythm control for AFMR are warranted.

show abstract

Atrial functional versus ventricular functional mitral regurgitation: Prognostic implications

Cited by 27 publications

References 24 publications

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

Variable definitions and treatment approaches for atrial functional mitral regurgitation: A scoping review of the literature

Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction

Outcomes of transcatheter edge‐to‐edge repair for atrial functional mitral regurgitation: A meta‐analysis of observational studies

Contact Info

Product

Resources

About