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Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week (JACC May 2019-2)

Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Although both AF and HFpEF—two closely related disease epidemics of the 21st century—are held responsible, current guidelines do not emphasize differentiating atrial functional MR from (ventricular) secondary MR. This overview article summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights as compared with secondary MR and suggesting potential therapeutic targets.


Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Sébastien Deferm, MD

Philippe B. Bertrand, MD, PHD

Pieter M. Vandervoort, MD

CME Information

Target Audience

JACC Journal CME/MOC/ECME is intended for physicians who treat patients with cardiovascular disease.

Important Dates

Date of Release: May 13, 2019
Term of Approval/Date of CME/MOC/ECME Expiration: May 12, 2020

Learner Objectives

After reading this article the reader should be able to:

  • Differentiate the pathophysiological background of atrial functional mitral regurgitation (MR) from secondary MR in the context of left ventricular disease.
  • Identify atrial functional MR based on patient symptoms, clinical presentation, and characteristic imaging findings.
  • Define the optimal medical and therapeutic treatment strategy for atrial functional MR.

Method of Participation and Claiming Credit
This ACC JACC Journals CME/MOC/ECME activity includes the reading of an article published in one of the JACC journals and the successful completion of self-assessment questions.  

Requesting AMA PRA Category 1 CME Credit™ and/or MOC, or ECME credit for this Activity
To request credit, you must:

  1. Read the article for which you wish to receive credit.
  2. Answer the self-assessment questions. You need to have achieved a passing score of 70% or better in order for the Evaluation link to become activated. If you did not achieve a passing score, please click on the Posttest link in the left navigation bar and retake the exam.
  3. After you complete the Evaluation, click on the Claim Credit button in the left navigation bar.
  4. For CME credit, enter the total amount of time you actually spent in the activity in the box provided. Please note that you may only claim once for this activity. Click Claim.
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  7. The page will be updated with the date and time that you claimed your credit.
  8. To view your credit, or to print a certificate, please go to and navigate to the My Transcript section of My ACC.

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Availability: On-Demand
Cost: FREE
Credit Offered: 1 CME Credit
1 ECME Credit
1 MOC Credit
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