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Incidence of atrial functional mitral regurgitation in patients with paroxysmal and persistent atrial fibrillation
Date Issued |
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2023-03-30 |
Introduction In most cases the main cause of atrial functional mitral regurgitation (AFMR) is atrial, not ventricular dilatation, usually due to long-standing atrial fibrillation (AF). AFMR is also associated with left ventricular (LV) diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) (1). LV size, leaflet motion and systolic function are typically normal. Echocardiography is contemplated to be the dominant diagnostic method of the evaluation of mitral valve (MV)disease (2). The incidence of AF and HFpEF is growing due to the aging of the population. It is expected that AFMR diagnosis will soon become a major health problem (3). Aim The aim is to assess the incidence of atrial functional mitral regurgitation in patients with paroxysmal and persistent atrial fibrillation according to echocardiography results. Methods We retrospectively analyzed medical data of patients diagnosed with paroxysmal and persistent AF who underwent 2D echocardiography in the Hospital of Lithuanian University of Health Sciences Kaunas Clinics from January 1st, 2021 to July 1st, 2021. The total of 123 patients were analyzed, we excluded patients with secondary mitral regurgitation (MR) (post myocardial infarction, dilated cardiomyopathy, systolic left ventricular dysfunction (ejection fraction (EF)<50%), restricted leaflet tethering) and primary MR (valve pathology, MV prolapse). We included patients with normal LV systolic function (EF >50%), without segmental wall motion abnormalities and with normal leaflet motion without any evident morphological changes of the MV leaflets. MR was evaluated qualitatively and semiquantitatively using vena contracta. A total of 44 eligible patients were selected. Based on the findings of 2D echocardiography, we calculated the incidence of AFMR. Data analysis was performed using SPSS Statistics, continuous variables were expressed as mean ± standard deviation (SD), p values <0,05 were considered as a statistically significant result. Results From the total of 44 eligible patients, 47,7% (n=21) were diagnosed with paroxysmal AF and52,3% (n=23) with persistent AF. Left atrium size (from parasternal long axis) was 44,70 ± 6,53mm, left atrium volume was 97,81 ± 32,15 ml, LV EF was 53,07 ± 2,90%. MR was identified in84,1% (n=37) of patients: 40,9% (n=18) had mild (grade I) MR, 31,8% (n=14) had moderate(grade II) MR, 11,4% (n=5) had moderate to severe (grade II-III) MR. There were no patients with severe (grade III) MR. As no other cause of MR was identified, it was considered to be due to AF. The absence of MR was registered in 15,9% (n=7) patients. The grade of MR did not depend on the type of AF (p=0,235). Larger left atrium size was associated with higher MR grade(ϱ=0,30; p=0,047). Persistent AF was related to larger size of left atrium, paroxysmal AF was associated with smaller left atrium (t=-3,07; p=0,004).Conclusions Our study revealed that the incidence of atrial functional mitral regurgitation in patients with paroxysmal and persistent atrial fibrillation was 84,1%. Almost half of those patients had mild MR and the other half had moderate or moderate to severe MR.