Incidence and causal association of functional atrial mitral regurgitation in HFpEF

Hellenic J Cardiol. 2023 Jan-Feb:69:51-56. doi: 10.1016/j.hjc.2022.09.013. Epub 2022 Sep 29.


Heart failure with preserved ejection fraction (HFpEF) is as common as heart failure with reduced ejection fraction. Atrial fibrillation (AF), as well as the presence of mitral regurgitation (MR), is highly prevalent in these patients. Atrial functional MR (AFMR) is a type of functional MR characterized by severe left atrial dilatation and remodeling with normal left ventricular (LV) dimensions and function. Dilatation of the mitral annulus is considered to be the main underlying mechanism, though the leaflets and the rest of the mitral apparatus play significant role in the development of MR, mainly in patients with long standing AF. There are several echocardiographic differences between atrial and ventricular functional MR, better identified with 3D echocardiography. Significant AFMR impairs prognosis, especially of patients with HFpEF, and this is important while they represent a group of under-diagnosed and under-treated patients. Finally, because focused medical evidence-based approach is not available yet, it seems that the prevention of left atrial dilatation and early restoration of sinus rhythm (SR) is the best therapeutic option.

Keywords: HFpEF; functional atrial mitral regurgitation; functional ventricular mitral regurgitation.

Publication types

  • Review

MeSH terms

  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Cardiomegaly
  • Heart Failure* / complications
  • Heart Failure* / etiology
  • Humans
  • Incidence
  • Mitral Valve Insufficiency* / complications
  • Mitral Valve Insufficiency* / diagnostic imaging
  • Mitral Valve Insufficiency* / epidemiology
  • Stroke Volume