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.

Editors

Editor-in-Chief
Valentin Fuster, MD, PhD, MACC

CME Editor
Ragavendra R. Baliga, MD

Authors
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.

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