Atrial Functional Mitral Regurgitation: Effect of Phenotype Definition on Classification, Valve Features, and Prognosis - PubMed

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Atrial functional mitral regurgitation (AfMR) is a distinct type of functional mitral regurgitation (fMR) with significant clinical implications.
Variability in published definitions of AfMR leads to uncertainty about prevalence, morphology, and mortality, affecting clinical decision-making.
A JACC Expert Consensus proposed a definition for AfMR, which was later challenged by the European Society of Cardiology (ESC) valve guidelines.
The study conducted sensitivity analyses on various AfMR definitions, focusing on classification, valve features, population characteristics, and prognosis.
Seventy-two unique AfMR definitions were identified, showing wide variability in prevalence (2%-62%), valve features, and outcomes.
The JACC and ESC definitions had similar overall prevalence but defined different populations, with differences in left atrial thresholds and inclusion criteria.
Both definitions were associated with higher mortality compared to moderate fMR, but only the JACC definition remained significant after multivariate adjustment.
The JACC definition demonstrated robust prognostic validity and adaptability, including cases with restrictive posterior leaflet (Carpentier IIIb) configurations.
The study suggests the JACC definition provides a solid foundation for a unified, clinically applicable AfMR definition.

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