[Atrial functional mitral regurgitation. Three-dimensional echocardiographic study]

Abstract

Introduction and objectives: Atrial fibrillation can lead to left atrium remodelling and induce functional mitral regurgitation. The aim of this study is to establish those features of the mitral annulus that are related to atrial functional mitral regurgitation.

Methods: A total of 29 patients with persistent atrial fibrillation and 36 controls in sinus rhythm were retrospectively enrolled. The characteristics of the mitral annulus were analysed by three-dimensional transoesophageal echocardiography in both groups. The 2D and 3D echocardiographic parameters were correlated with the effective regurgitant orifice.

Results: Patients with atrial fibrillation had a larger left atrium volume, anteroposterior diameter at end-diastole, and lower percentage of change in this diameter (P=.015, P=.019 and P<.001, respectively). In the multiple regression analysis, the ellipticity index (β: -0.756, P=.004) and height-anterolateral-posteromedial diameter ratio (β: -0704, P=.003) were independent parameters that correlated with the effective regurgitant orifice (R²: 0.699, P=.019) in patients with atrial fibrillation.

Conclusions: Atrial fibrillation leads to atrial dilation and alterations in the size and dynamics of the anteroposterior diameter, producing a circular mitral annulus. The independent determining factors of atrial functional mitral regurgitation in the atrial fibrillation group were the ellipticity index and the height-anterolateral-posteromedial diameter ratio.

Keywords: Atrial fibrillation; Aurícula izquierda; Ecocardiografía tridimensional; España; Fibrilación auricular; Insuficiencia mitral; Left atrium; Mitral regurgitation; Spain; Three-dimensional echocardiography.