The Relationship Between Atrial Fibrillation, Mitral Regurgitation, and Heart Failure Subtype: The ARIC Study

Arora, Sameer; Brown, Zachary D.; Sivaraj, Krishan; Hendrickson, Michael; Mazzella, Anthony J.; Chang, Patricia; Vaduganathan, Muthiah; Qamar, Arman; Gehi, Anil K.; Pandey, Ambarish; Vavalle, John P.

doi:10.1016/j.cardfail.2021.10.015

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…Although the mechanism of mitral regurgitation was not specified, most probably the majority of the patients had AMR since patients with primary mitral regurgitation would have been excluded as per study design. The proportion of female was comparable among patients with and without AF (67 vs. 65%, respectively) and the frequency of AF increased with increasing severity of mitral regurgitation ( 28 ). Therefore, it could be inferred that the prevalence of AMR would be higher in women than in men.…”

Section: Differences In Prevalence Of Amr Between Women and Menmentioning

confidence: 92%

Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men

Gual-Capllonch

Ibarra

Bayés‐Genís

et al. 2022

Front. Cardiovasc. Med.

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Atrial functional regurgitation is caused by atrioventricular annulus dilation, with normal leaflets and ventricular dimensions and function within the normal range. Its occurrence, in both mitral and tricuspid valves, implies a worse prognosis due to the hemodynamic derangement they produce, but also constitutes a marker of greater comorbidity and more advanced disease. Predisposing conditions for these heart valve dysfunctions are mainly atrial fibrillation and heart failure with preserved ejection fraction. However, other factors like female sex also may be involved and influence their incidence, especially for atrial tricuspid regurgitation. In the present review, we analyze sex differences in the reported prevalence of atrial mitral and tricuspid regurgitation, and suggest possible mechanisms involved. Finally, we underline potential therapeutic and preventive strategies to reduce the burden of these heart valve disorders and discuss research gaps.

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Section: Differences In Prevalence Of Amr Between Women and Menmentioning

confidence: 92%

Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men

Gual-Capllonch

Ibarra

Bayés‐Genís

et al. 2022

Front. Cardiovasc. Med.

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“…The synergism between atrial fibrillation (AF) and heart failure comprises of bi‐directional aspects in which AF promotes heart failure and vice versa. The Atherosclerosis Risk in Communities (ARIC) study 41 found AF prevalence to increase with MR severity, but importantly, that this effect was more pronounced in heart failure with preserved ejection fraction (HFpEF) rather than reduced ejection fraction. AF was associated with an increased 1‐year mortality only in patients with HFpEF and concomitant moderate/severe MR 41 .…”

Section: Atrial Fibrillation and Functional Atrial Mitral Regurgitationmentioning

confidence: 99%

“…The synergism between atrial fibrillation (AF) and heart failure comprises of bi-directional aspects in which AF promotes heart failure and vice versa. The Atherosclerosis Risk in Communities (ARIC) study 41 found AF prevalence to increase with MR severity, but importantly, that this effect was more pronounced in heart failure with preserved ejection fraction (HFpEF) rather than reduced ejection fraction. AF was associated with an increased 1-year mortality only in patients with HFpEF and concomitant moderate/severe MR. 41 A reduction in atrial functional MR (aFMR) has been demonstrated following TEER, 42 probably due to an increase in leaflet coaptation area, but has also been associated with worsening TR.…”

Section: Atrial Fibrillation and Functional Atrial Mitral Regurgitationmentioning

confidence: 99%

Peri‐procedural management of transcatheter mitral valve replacement in patients with heart failure

Hungerford

Dahle

Duncan

et al. 2022

European J of Heart Fail

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Over the past decade, transcatheter mitral valve replacement (TMVR) technologies have evolved with the objective of improving outcomes for patients with severe mitral regurgitation (MR) deemed unsuitable for conventional mitral valve surgery. Although the safety and efficacy of transcatheter edge‐to‐edge mitral valve repair (TEER) is well‐established, there is a sense amongst innovators that a major advantage of TMVR may be to offer a more complete solution for the correction of MR in patients whose complex anatomy means that the likelihood of achieving grade 0 or 1 MR with TEER is low. However, abrupt correction of MR in a poorly prepared left ventricle poses a number of unique haemodynamic challenges, particularly when sudden elimination of regurgitant flow causes a relative increase in left ventricular (LV) afterload. Rapid reduction in LV cavity size following MR elimination may itself result in relative LV outflow tract obstruction (LVOTO), irrespective of the intrinsic risk of LVOTO associated with TMVR. Nevertheless, TMVR on a beating heart affords the opportunity to study real‐time invasive cardiac indices in high‐risk patients with acute reversal of severe MR.

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“… 12 Similarly, after analysis of acute decompensated heart failure hospitalization, the prevalence of AF increased with increased MR severity. 18 Although previous studies have clarified the relationship between MR and AF, few studies have been performed in postoperative critically ill patients. Additionally, no prior study has established the prediction model using MR in POAF patients.…”

Section: Introductionmentioning

confidence: 99%

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

Zhang¹,

Wang²,

Jiang³

et al. 2023

IJGM

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Purpose Atrial fibrillation (AF) is common in critically ill patients and can have serious consequences. Postoperative AF (POAF) in critically ill patients following noncardiac surgery has been understudied, contrary to cardiac procedures. Mitral regurgitation (MR) is associated with left ventricular dysfunction, which might contribute to the occurrence of AF in postoperative critically ill patients. This study aimed to investigate the association between MR and POAF in critically ill noncardiac surgery patients and establish a new nomogram for the prediction of POAF in critically ill noncardiac surgery patients. Patients and Methods A prospective cohort of 2474 patients who underwent thoracic and general surgery was enrolled in this study. Data on preoperative transthoracic echocardiography (TTE), electrocardiogram (ECG), and several commonly utilized scoring systems (CHA2DS2‐VASc, HATCH, COM-AF, HART, and C2HEST) and baseline clinical data were collected. Independent predictors were selected by univariate and multivariable logistic regression analysis, and a nomogram was constructed for POAF within 7 days after postoperative intensive care unit (ICU) admission. The ability of the MR-nomogram and other scoring systems to predict POAF was compared by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Additional contributions were evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) analysis. Results A total of 213 (8.6%) patients developed POAF within 7 days after ICU admission. Compared to CHA2DS2‐VASc, HATCH, COM-AF, HART, and C2HEST scoring systems, MR-nomogram showed better predictive ability for POAF with an area under the ROC curve of 0.824 (95% confidence interval: 0.805–0.842, p < 0.001). The improvement of the MR-nomogram in predictive value was supported by NRI and IDI analysis. The net benefit of the MR nomogram was maximal in DCA. Conclusion MR is an independent risk factor of POAF in critically ill noncardiac surgery patients. The nomogram predicted POAF better than other scoring systems.

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The Relationship Between Atrial Fibrillation, Mitral Regurgitation, and Heart Failure Subtype: The ARIC Study

Cited by 7 publications

References 29 publications

Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men

Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men

Peri‐procedural management of transcatheter mitral valve replacement in patients with heart failure

Association of Mitral Regurgitation with Postoperative Atrial Fibrillation in Critically Ill Noncardiac Surgery Patients: A Prospective Cohort Study

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