Photo Credit: ttsz
The following is a summary of “Impact of Exercise on Atrial Functional Mitral Regurgitation and its Determinants: An Exercise Echocardiographic Study,” published in the January 2025 issue of Cardiology by Schutter et al.
Atrial functional mitral regurgitation (AFMR), a distinct type of mitral regurgitation observed in patients with atrial fibrillation and heart failure with preserved ejection fraction (HFpEF), has an unclear pathophysiology, and the impact of exercise on its severity remains largely unexplored.
Researchers conducted a retrospective study to investigate the impact of acute exercise on AFMR severity and identify the contributing factors to its progression.
They enrolled 47 participants (39 with HFpEF and 22 with atrial fibrillation) and assessed AFMR severity, mitral annular dimensions, left atrial size, and systolic and diastolic function at rest and during maximal exercise using echocardiography.
The results showed 20 patients (43%) had an increase of ≥1 grade in AFMR severity during exercise, linked to impaired progression of peak mitral annulus systolic velocity (Med S’) and an increase in systolic mitral annular diameter. In patients without AFMR progression, the systolic annular diameter decreased. Additionally, 19 patients (40%) with ≥moderate AFMR during exercise had lower Med S’, larger systolic mitral annular diameters, reduced tricuspid annular plane systolic excursion, and more severe tricuspid regurgitation than those with ≤mild MR.
Investigators concluded the AFMR worsened during exercise, linked to impaired left ventricular contractile reserve and larger mitral annular dimensions, indicating that AFMR may result from an imbalance between the mitral annulus and leaflet areas due to annular dilation and impaired function.
Source: ajconline.org/article/S0002-9149(25)00001-3/abstract
