Sex-Related Disparities In Atrial Functional Mitral Regurgitation.

Abstract

Background Atrial functional mitral regurgitation (AFMR) is an increasingly recognized entity associated with left atrial dilation secondary to heart failure with preserved ejection fraction (HFpEF) and/or atrial fibrillation. Little is known about AFMR in females. Methods A retrospective chart review, of all patients over the age of 18 years who underwent a transthoracic echocardiogram (TTE) between Oct 1st 2019 and April 30th 2020 and were found to have moderate-to-severe and severe mitral regurgitation (MR), was performed. Key exclusion criteria included presence of: mitral valve repair or replacement, rheumatic mitral valve disease, mitral valve pathology such as perforation, cleft or endocarditis, congenital heart disease, left ventricular assist device or heart transplant, poor quality echocardiogram. Categorical variables (proportions) were compared using chi-squared test. Results Four hundred and twenty patients were found to have moderate-to-severe/severe mitral regurgitation. Of them, 51 were excluded based on the aforementioned criteria. Three hundred and sixty nine patients met inclusion criteria, including 192 (52%) females. Of them, 56 (15%) patients had primary or degenerative MR (DMR); 250 (68%) patients had left ventricular ejection fraction (LVEF) ≤ 50% and were classified as ventricular functional MR (VFMR); 45 (12%) patients had LVEF ≥ 50% with severe left atrial enlargement (left atrial biplane volume index > 40 ml/m2) and were classified as having AFMR; 3 (0.8%) patients had MR secondary to leaflet tethering; and in 15 (4%) patients the mechanism of MR was unclear. Remarkably, 80% (36) of patients with AFMR were females as compared to 54 % (30) patients with DMR and 46% (115) patients with VFMR (p< 0.001). Of the 162 female patients with FMR, 36 (22%) had AFMR. Notably, 27(60%) patients with AFMR carried a diagnosis of atrial fibrillation, 22 (49%) had been diagnosed with HFpEF, and 36 (80%) had hypertension. Conclusion There is a considerable burden of AFMR in females. Females are more likely to develop HFpEF and atrial fibrillation in women is also more likely to result in HFpEF, thereby portending increased risk of AFMR. Further research is needed to examine sex-related disparities in AFMR. Atrial functional mitral regurgitation (AFMR) is an increasingly recognized entity associated with left atrial dilation secondary to heart failure with preserved ejection fraction (HFpEF) and/or atrial fibrillation. Little is known about AFMR in females. A retrospective chart review, of all patients over the age of 18 years who underwent a transthoracic echocardiogram (TTE) between Oct 1st 2019 and April 30th 2020 and were found to have moderate-to-severe and severe mitral regurgitation (MR), was performed. Key exclusion criteria included presence of: mitral valve repair or replacement, rheumatic mitral valve disease, mitral valve pathology such as perforation, cleft or endocarditis, congenital heart disease, left ventricular assist device or heart transplant, poor quality echocardiogram. Categorical variables (proportions) were compared using chi-squared test. Four hundred and twenty patients were found to have moderate-to-severe/severe mitral regurgitation. Of them, 51 were excluded based on the aforementioned criteria. Three hundred and sixty nine patients met inclusion criteria, including 192 (52%) females. Of them, 56 (15%) patients had primary or degenerative MR (DMR); 250 (68%) patients had left ventricular ejection fraction (LVEF) ≤ 50% and were classified as ventricular functional MR (VFMR); 45 (12%) patients had LVEF ≥ 50% with severe left atrial enlargement (left atrial biplane volume index > 40 ml/m2) and were classified as having AFMR; 3 (0.8%) patients had MR secondary to leaflet tethering; and in 15 (4%) patients the mechanism of MR was unclear. Remarkably, 80% (36) of patients with AFMR were females as compared to 54 % (30) patients with DMR and 46% (115) patients with VFMR (p< 0.001). Of the 162 female patients with FMR, 36 (22%) had AFMR. Notably, 27(60%) patients with AFMR carried a diagnosis of atrial fibrillation, 22 (49%) had been diagnosed with HFpEF, and 36 (80%) had hypertension. There is a considerable burden of AFMR in females. Females are more likely to develop HFpEF and atrial fibrillation in women is also more likely to result in HFpEF, thereby portending increased risk of AFMR. Further research is needed to examine sex-related disparities in AFMR.