Backround:
Mitral regurgitation (MR) is classified as primary (or organic) MR and secondary (or functional) MR. Functional MR is caused by atrial and/or ventricular enlargement. Atrial fibrillation may cause/aggravate MR by leading to tachymyopathy and ventricular enlargement or by atrial enlargement. This retrospective study was designed to establish predictors that may help to identify patients with MR who benefit from restoration of sinus rhythm.
Methods:
Patients with atrial arrhythmias (atrial fibrillation (AF) and atrial flutter (Aflut)) and at least moderate MR undergoing either cardioversion or ablation and echocardiographic follow up within 1-6 months after the procedure were included. Patients with apparent primary MR or AF or Aflut recurrence were excluded from the analysis. Baseline and echocardiographic parameters of patients with or without MR improvement were compared.
Results:
74 patients (64,9% (48/74) male, 71.0 ± 10,3 years old) were included. Echocardiographic follow up was performed after 13,0 ± 10,8 weeks. Significant MR improvement (at least one grade) was observed in 36 of 74 patients (see figure 1).
Impairment of LVEF and tachycardic heartrate during AF or Aflut were associated with a higher likelihood of MR improvement after restoration of sinus rhythm, whereas other echocardiographic parameters like left atrial volume, coaptation depth and mitral annulus diameter were not different between the two groups (see table 1).
Conclusion:
In this retrospective analysis of patients with at least moderate MR in AF or Aflut a high proportion of patients showed an improvement of MR after restoration of sinus rhythm. Impairment of LVEF and tachycardia were associated with significant MR improvement.
Figure 1: MR severity at baseline and follow-up, shown in %
|
|
MR improvement |
No MR improvement |
p-value |
|
|
n = 36 |
n = 38 |
|
|
Baseline characteristics |
|
|
|
|
Age, mean (±SD) |
69.5 (±10,6) |
72,4 (±10,0) |
0.230 |
|
Male, n (%) |
26 (72.2) |
22 (57.9) |
0.197 |
|
Heart failure, n (%) |
22 (61.1) |
17 (44.7) |
0.159 |
|
Hypertension, n (%) |
27 (75.0) |
32 (88.9) |
0.212 |
|
4 (11.1) |
13 (34.2) |
0.032 |
|
|
Coronary heart disease, n (%) |
16 (44.4) |
15 (39.5) |
0.665 |
|
COPD, n (%) |
2 (5.6) |
5 (13.2) |
0.264 |
|
Tachycardia at baseline ECG, n (%) |
27 (75.0) |
19 (50.0) |
0.027 |
|
|
|
|
|
|
Echocardiographic parameters |
|
|
|
|
LVEF [%], mean (±SD) |
43.2 (±15.5) |
49.8 (±12.6) |
0.325 |
|
LVEF < 50%, n (%) |
23 (63.9) |
14 (36.8) |
0.028 |
|
LA size [ml], mean (±SD) |
99.5 (±29.7) |
100.2 (±29.6) |
0.687 |
|
LVEDD [mm], mean (±SD) |
53.2 (±8.5) |
52.0 (±7.8) |
0.627 |
|
MA diameter [mm], mean (±SD) |
39.3 (±4.9) |
39.4 (±5.9) |
0.494 |
|
Coaptation depth [mm], mean (±SD) |
2.94 (±2.0) |
2.47 (±2.2) |
0.280 |
|
Vena contracta [mm], mean (±SD) |
6.22 (±2.14) |
6.32 (±1.86) |
0.645 |
n = number; SD = standard deviation;
n = number; SD = standard deviation; MR = mitral regurgitation; COPD = chronic obstructive pulmonary disease; LVEF = left ventricular ejection fraction; LA = left atrial; ml = milliliter; LVEDD = left ventricular end diastolic diameter; MA = mitral annulus; mm = millimeter
Table 1: Comparison of baseline characteristics and echocardiographic parameters at baseline in patients with or without improvement of mitral regurgitation of at least one grade after restoration of sinus rhythm
https://dgk.org/kongress_programme/ht2021/P773.htm