Is the minimal mitral regurgitation a marker of high blood pressure, and can predispose to the appearance of atrial fibrillation?

Abstract

Abstract Background Leonardo da Vinci intuited that the cardiac valves were the key to the functioning of the heart. Minimal mitral regurgitation (MMR) in young's is often interpreted as haemodynamically insignificant, it is attributed that it starts from birth or named para-physiologic effect. Pathophysiological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). Purpose The aim of this study is to know if the presence of MMR is a consequence of the High Blood Pressure (BP), and whether in the own evolution can contribute to the appearance of the AF. Methods For this cross-sectional retrospective study, data were collected from 436 patients. Female-Male: 249–187 from the 20 to the 89 years old, mean age (±SD) 59.6 (16.5) – 59.7 (16.1), divided and analyzed in each one of them all 7 decades. All patients had MMR. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The measures of BP were registered in mmHg. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The Central Haemodynamic Parameters (CHP) were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (between the normal levels and the observed values) was assessed according to the normal range by age. Results In all patients female - male, the mean (±SD) of SBP/DBP 142.7 (24.5)/83.7 (13.6) – 137.7 (20.2)/82.4 (11.3) was higher than normal levels of BP accepted by ESC/ESH. All measures of CHP and SBP/DBP increased with age in each decade, in female from the 20s 120.3 (18.9)/76.7 (14.1) to the 80s 160.4 (21.1)/86.0 (25), and in male from the 20s 133.7 (16.7)/78.9 (6.4) to the 70s 142.8 (23.5)/78.8 (12.4), but slightly decreased in the 80s 138.4 (20.4)/76.6 (8.0). The difference of Augmentation index (surrogate value of arterial stiffness) in all decades was higher too, for both genders. In the adult total sample, in female - male the AF reached 26.5% - 27.8%, beginning after 33 years old, and strongly increased its prevalence after the 60s to a top of 50.0% - 43.8% at 80s. Conclusions MMR can be an early marker of high BP levels, the prevalence increasing with age, and it would be a predisposing condition to evolving to AF. The appearance of MMR principally among younger can indicate that the brachial BP found is higher than “normal”, needing any time to modify the original ventricular geometry toward myocardial remodelling, Therefore, it should be reassessed the optimal levels of BP to avoid its complication. Funding Acknowledgement Type of funding sources: None.