Insufficient Leaflet Remodeling in Patients With Atrial Fibrillation: Association With the Severity of Mitral Regurgitation. (March 2017)

• Record Type: Journal Article
• Authors: Kagiyama, Nobuyuki; Hayashida, Akihiro; Toki, Misako; Fukuda, Shota; Ohara, Minako; Hirohata, Atsushi; Yamamoto, Keizo; Isobe, Mitsuaki; Yoshida, Kiyoshi
• Is Part Of: Circulation. Volume 10:Number 3(2017)
• Publication Date: 2017-03
• Subjects: 3-dimensional echocardiography -- atrial fibrillation -- dilatation -- echocardiography -- mitral valve regurgitation; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.116.005451
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background—: The relationship between annular dilatation caused by atrial fibrillation (AF) and mitral regurgitation (MR) remains controversial. We hypothesized that the small ratio of total leaflet area/annulus area (TLA/AA), reflecting insufficient leaflet remodeling to annular dilatation, is a main component of MR in patients with AF. Methods and Results—: Three-dimensional transesophageal echocardiographic data of the mitral valve were analyzed in 28 AF patients with moderate or severe MR (MR group), age- and sex-matched 56 AF patients with mild or less MR (non-MR group), and 16 control subjects. AA was significantly greater in both the MR (645±126 mm 2 /m 2, P <0.001) and non-MR groups (568±121 mm 2 /m 2, P =0.001) compared with control subjects (444±108 mm 2 /m 2 ). However, TLA/AA was significantly smaller in the MR (1.29±0.10, P <0.001), but not in the non-MR group (1.65±0.24, P >0.99), compared with control subjects (1.70±0.29). In linear regression analysis, TLA/AA was inversely associated with the effective regurgitant orifice ( r =−0.73, P <0.001). The area under the receiver-operating-characteristics curve of TLA/AA was significantly greater than that of AA (0.95 versus 0.72, P <0.001). Multivariable analysis revealed that small TLA/AA ( P <0.001) was independently associated with significant MR, while AA was not ( P =0.26). Conclusions—: In patients with AF, insufficient leaflet remodeling to annular dilatation, rather than crude annular dilatation, was strongly associated with the severity of MR.