Mitral Annular Dynamics in AF Versus Sinus Rhythm Novel Insights Into the Mechanism of AFMR

JACC-CARDIOVASCULAR IMAGING

卷:15

Article

Deferm, Sebastien^1,2  Bertrand, Philippe B.^1,2  Verhaert, David¹  Verbrugge, Frederik H.²  Dauw, Jeroen^1,2  Thoelen, Kevin²  Giesen, Alexander²  Bruckers, Liesbeth³  Rega, Filip⁴  Thomas, James D.⁵  Levine, Robert A.⁶  Vandervoort, Pieter M.^1,2 

[1] Hosp Oost Limburg, Dept Cardiol, Genk, Belgium

[2] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium

[3] Hasselt Univ, Interuniv Inst Biostat & Stat Bioinformat, Data Sci Inst, Hasselt, Belgium

[4] Leuven Univ Hosp, Dept Cardiac Surg, Cardiovasc Sci, Leuven, Belgium

[5] Northwestern Univ, Bluhm Cardiovasc Inst, Dept Cardiol, Chicago, IL 60611 USA

[6] Massachusetts Gen Hosp, Dept Cardiol, Boston, MA 02114 USA

关键词: ' atrial functional mitral regurgitation;    electric cardioversion;    mitral annulus;    mitral regurgitation;    three-dimensional echocardiography;    atrial fibrillation;   

DOI  :  10.1016/j.jcmg.2021.05.019

来源: Elsevier

【 摘 要 】

OBJECTIVES This study aimed to investigate mitral annular dynamics in atrial fibrillation (AF) and after sinus rhythm restoration, and to assess the relationship between annular dynamics and mitral regurgitation (MR). BACKGROUND AF can be associated with MR that improves after sinus rhythm restoration. Mechanisms underlying this atrial functional MR (AFMR) are ill-understood and generally attributed to left atrial remodeling. METHODS Fifty-three patients with persistent AF and normal left ventricular ejection fraction were prospectively examined by means of 3-dimensional transesophageal echocardiography before, immediately after, and 6 weeks after electric cardioversion to sinus rhythm. Annular motion was assessed during AF and in sinus rhythm with the use of 3-dimensional analysis software, and the relationship with MR severity was explored. RESULTS During AF and immediately after sinus rhythm restoration, the mitral annulus behaved relatively adynamically, with an overall change in annular area of 10.3% (95% CI: 8.7%-11.8%) and 12.2% (95% CI: 10.6%-13.8%), respectively. At follow-up, a significant increase in annular dynamics (19.0%; 95% CI: 17.4%-20.6%; P < 0.001) was observed, owing predominantly to an increase in presystolic contraction (P < 0.001). The effective regurgitant orifice area decreased from 0.15 cm(2) (0.10-0.23 cm(2)) during AF to 0.09 cm(2) (0.05-0.12 cm(2)) at follow-up (P < 0.001) in the total cohort, and from 0.27 (0.23-0.33) to 0.16 (0.12-0.29) in the subgroup with effective regurgitant orifice area (EROA) >= 0.20 cm(2). The change in presystolic annular motion was the only independent determinant of the decrease in MR severity (P = 0.027), by optimizing annular-leaflet imbalance. Patients with more pronounced blunting of presystolic dynamics had a higher EROA (P < 0.001), because of a lower total-to-closed leaflet area ratio (P < 0.001) at each point in time. This ratio was the strongest independent determinant of AFMR severity (adjusted P = 0.003). CONCLUSIONS Mitral annular dynamics are impaired in AF, with blunted presystolic narrowing that contributes to AFMR. Sinus rhythm restoration allows gradual recovery of presystolic annular dynamics. Improved annular dynamics decrease AFMR severity by optimizing annular-leaflet imbalance, regardless of LA remodeling. (C) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

Free