Background: The prevalence, clinical characteristics, management and long-term outcomes of patients with atrial secondary mitral regurgitation (ASMR) are not well described. Methods: We performed a retrospective, observational study of consecutive patients with grade III/IV MR determined by transthoracic echocardiography. The aetiology of MR was grouped as being either primary (due to degenerative mitral valve disease), ventricular SMR (VSMR: due to left ventricular dilatation/dysfunction), ASMR (due to LA dilatation), or other. Results: A total of 388 individuals were identified who had grade III/IV MR; of whom 37 (9.5%) had ASMR, 113 (29.1%) had VSMR, 193 had primary MR (49.7%), and 45 (11.6%) were classified as having other causes. Compared to MR of other subtypes, patients with ASMR were on average older (median age 82 [74–87] years, p < 0.001), were more likely to be female (67.6%, p = 0.004) and usually had atrial fibrillation (83.8%, p = 0.001). All-cause mortality was highest in patients with ASMR (p < 0.001), but similar to that in patients with VSMR once adjusted for age and sex (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.52–1.25). Hospitalisation for worsening heart failure was more commonly observed in those with ASMR or VSMR (p < 0.001) although was similar between these groups when age and sex were accounted for (HR 0.74, 95% CI 0.34–1.58). For patients with ASMR, the only variables associated with outcomes were age and co-morbidities. Conclusions: ASMR is a prevalent and distinct disease process associated with a poor prognosis, with much of this related to older age and co-morbidities. Graphical Abstract: [Figure not available: see fulltext.]
CITATION STYLE
Straw, S., Gupta, A., Johnson, K., Cole, C. A., Kneizeh, K., Gierula, J., … Schlosshan, D. (2023). Atrial secondary mitral regurgitation: prevalence, characteristics, management, and long-term outcomes. Echo Research and Practice, 10(1). https://doi.org/10.1186/s44156-023-00015-y
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