Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation

Sharma, Sanjiv; Lardizabal, Joel A.; Monterroso, Mark; Bhambi, Neil; Sharma, Rohan; Sandhu, Rasham; Singh, Sarabjeet

doi:10.4330/wjc.v4.i5.183

Cited by 13 publications

(7 citation statements)

References 24 publications

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“…Interestingly, the left ventricular diameters in systole and diastole were not different from those in the SHAM pigs, while the left ventricular end-diastolic and endsystolic volumes both were considerably increased, implying that the left ventricle was nevertheless dilated. Clinically unrecognized mitral regurgitation has been observed to be prevalent in patients with atrial fibrillation -either as an etiologic factor leading to atrial fibrillation or developing after onset of atrial fibrillation (19). Mitral regurgitation was observed in all of the A-TP pigs and none of the SHAM pigs in the current study, lending support to the hypothesis that atrial fibrillation can cause functional mitral regurgitation (6)(7)(8), most likely due to dilatation of the mitral ring.…”

Section: Echocardiographic Signs Of Atrial and Ventricular Dysfunctionsupporting

confidence: 79%

Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing

et al. 2020

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Background: Atrial fibrillation (AF) is characterized by electrical and structural remodeling. Irregular and/or fast atrio-ventricular (AV) conduction during AF can result in AV dyssynchrony, tachymyopathy, pressure and volume overload with subsequent dilatation, valve regurgitation, and ventricular dysfunction with progression to heart failure. Objective: To gain further insight into the myocardial pathophysiological changes induced by right atrial tachypacing (A-TP) in a large animal model. Methods: A total of 28 Landrace pigs were randomized as 14 into AF-induced A-TP group and 14 pigs to control group. AF pigs were tachypaced for 43 ± 4 days until in sustained AF. Functional remodeling was investigated by echocardiography (after cardioversion to sinus rhythm). Structural remodeling was quantified by histological preparations with picrosirius red and immunohistochemical stainings. Results: A-TP resulted in decreased left ventricular ejection fraction (LVEF) accompanied by increased end-diastolic and end-systolic left atrium (LA) volume and area. In addition, A-TP was associated with mitral valve (MV) regurgitation, diastolic dysfunction and increased atrial and ventricular fibrotic extracellular matrix (ECM). Conclusions: A-TP induced AF with concomitant LV systolic and diastolic dysfunction, increased LA volume and area, and atrial and ventricular fibrosis.

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Section: Echocardiographic Signs Of Atrial and Ventricular Dysfunctionsupporting

confidence: 79%

Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing

et al. 2020

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“…It is known that significant mitral regurgitation (from degenerative causes or organic valvular abnormalities), through increase in LA size, is associated with development of AF, at a rate of about 5% per year. 22 Coronary angiography revealed an association between new-onset AF and the absence of coronary lesions and lower rates of revascularization. The former could be a consequence of early reperfusion after a thromboembolic event or simply the result of an imbalance between myocardial oxygen supply and demand caused by the tachyarrhythmia.…”

Section: Discussionmentioning

confidence: 98%

New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis

Braga

Ramos

Vieira

et al. 2014

Revista Portuguesa de Cardiologia

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“…With the development of 3D-TEE, high-resolution imaging and quantification of the morphology of the entire mitral apparatus have become feasible [ 7 – 10 ]. 3D-TEE studies of MV geometry have led to a new understanding of the pathogenesis of functional MR. [ 11 , 12 ] Few data exist on the relationship between the 3D morphology of the MV and the degree of MR in AF, which is a common cause of functional MR. [ 3 , 13 ] Therefore, we undertook a 3D-TEE study in patients with AF to investigate the relationship between 3D MV morphology and clinically moderate to severe MR.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation

Cong

Lee

et al. 2018

Cardiovasc Ultrasound

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BackgroundAtrial fibrillation (AF) can result in atrial functional mitral regurgitation (MR), but the mechanism remains controversial. Few data about the relationship between the 3-dimensional morphology of the MV and the degree of MR in AF exist.MethodsReal-time 3-dimensional transesophageal echocardiography (3D-TEE) of the MV was acquired in 168 patients with AF (57.7% persistent AF), including 25 (14.9%) patients with moderate to severe MR (the MR+ group) and 25 patients without AF as controls. The 3-dimensional geometry of the MV apparatus was acquired using dedicated quantification software.ResultsCompared with the group of patients with no or mild MR (the MR- group) and the controls, the MR+ group had a larger left atrium (LA), a more dilated mitral annulus (MA), a reduced annular height to commissural width ratio (AHCWR), indicating flattening of the annular saddle shape, and greater leaflet surfaces and tethering. MR severity was correlated with the MA area (r2 = 0.43, P < 0.01) and the annulus circumference (r2 = 0.38, P < 0.01). A logistic regression analysis indicated that the MA area (OR: 1.02, 95% CI: 1.01–1.03, P < 0.01), AHCWR (OR: 0.24, 95% CI: 0.14–0.35, P = 0.04) and MV tenting volume (OR: 3.24, 95% CI: 1.16–9.08, P = 0.03) were independent predictors of MR severity in AF patients.ConclusionsThe mechanisms of “atrial functional MR” are complex and include dilation of the MA, flattening of the annular saddle shape and greater leaflet tethering.

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Clinically unrecognized mitral regurgitation is prevalent in lone atrial fibrillation

Abstract: Clinically unrecognized moderate MR is prevalent in "lone" AF -either as an etiologic factor leading to "lone" AF or developing after onset of AF.

Cited by 13 publications

References 24 publications

Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing

Characterization of Atrial and Ventricular Structural Remodeling in a Porcine Model of Atrial Fibrillation Induced by Atrial Tachypacing

New-onset atrial fibrillation during acute coronary syndromes: Predictors and prognosis

Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation

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