- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
XIONG Tianyuan,
Email: xiongtianyuan@wchscu.cn
Atrial functional mitral regurgitation (AFMR) is characterized by left atrial enlargement, without left ventricular dilation or systolic dysfunction, and with structurally normal leaflet tissue. It predominantly occurs in patients with atrial fibrillation and heart failure with preserved ejection fraction. The complex pathophysiological mechanisms involve mitral annular dilation, atriogenic leaflet tethering, and inadequate leaflet adaptation. Currently, standardized management protocols for AFMR remain lacking. Common approaches include pharmacotherapy, rhythm control, and surgical or percutaneous interventions, all requiring individualized therapeutic strategy based on etiology and clinical characteristics. This review discusses recent advances in the pathogenesis and treatment of AFMR, aiming to provide valuable insights for clinical practice and future research.
Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
| 1. | Kumanohoso T, Otsuji Y, Yoshifuku S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg, 2003, 125(1): 135-143. |
| 2. | Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol, 2011, 58(14): 1474-1481. |
| 3. | Farhan S, Silbiger JJ, Halperin JL, et al. Pathophysiology, echocardiographic diagnosis, and treatment of atrial functional mitral regurgitation: JACC state-of-the-art review. J Am Coll Cardiol, 2022, 80(24): 2314-2330. |
| 4. | Chen QF, Zhou X, Katsouras CS, et al. Atrial and ventricular functional mitral regurgitation: prevalence, characteristics, outcomes, and disease progression. Eur Heart J Cardiovasc Imaging, 2025, 26(3): 545-556. |
| 5. | Levy MJ, Edwards JE. Anatomy of mitral insufficiency. Prog Cardiovasc Dis, 1962, 5: 119-144. |
| 6. | Tanimoto M, Pai RG. Effect of isolated left atrial enlargement on mitral annular size and valve competence. Am J Cardiol, 1996, 77(9): 769-774. |
| 7. | Henry WL, Morganroth J, Pearlman AS, et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation, 1976, 53(2): 273-279. |
| 8. | Wozakowska-Kapłon B. Changes in left atrial size in patients with persistent atrial fibrillation: a prospective echocardiographic study with a 5-year follow-up period. Int J Cardiol, 2005, 101(1): 47-52. |
| 9. | Vaziri SM, Larson MG, Benjamin EJ, et al. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation, 1994, 89(2): 724-730. |
| 10. | Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol, 2002, 39(10): 1651-1656. |
| 11. | Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol, 2014, 11(9): 507-515. |
| 12. | Tamargo M, Obokata M, Reddy YNV, et al. Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail, 2020, 22(3): 489-498. |
| 13. | Reddy YNV, Obokata M, Verbrugge FH, et al. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Am Coll Cardiol, 2020, 76(9): 1051-1064. |
| 14. | Salgo IS, Gorman JH, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation, 2002, 106(6): 711-717. |
| 15. | Bai W, Chen Y, Zhong Y, et al. Assessment of mitral valve geometry in nonvalvular atrial fibrillation patients with or without ventricular dysfunction: insights from high volume rate three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging, 2023, 39(12): 2427-2436. |
| 16. | Cong T, Gu J, Lee AP, et al. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound, 2018, 16(1): 13. |
| 17. | Kim DH, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2019, 12(4): 665-677. |
| 18. | Silbiger JJ. Anatomy, mechanics, and pathophysiology of the mitral annulus. Am Heart J, 2012, 164(2): 163-176. |
| 19. | Silbiger JJ, Bazaz R. The anatomic substrate of mitral annular contraction. Int J Cardiol, 2020, 306: 158-161. |
| 20. | Deferm S, Bertrand PB, Verhaert D, et al. Mitral annular dynamics in AF versus sinus rhythm: novel insights into the mechanism of AFMR. JACC Cardiovasc Imaging, 2022, 15(1): 1-13. |
| 21. | Silbiger JJ. Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering. Echocardiography, 2014, 31(10): 1310-1311. |
| 22. | Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Novel mechanistic insights into atrial functional mitral regurgitation - 3-dimensional echocardiographic study. Circ J, 2016, 80(10): 2240-2248. |
| 23. | Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, et al. Tricuspid and mitral remodelling in atrial fibrillation: a three-dimensional echocardiographic study. Eur Heart J Cardiovasc Imaging, 2022, 23(7): 944-955. |
| 24. | Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation, 2008, 118(8): 845-852. |
| 25. | Debonnaire P, Al Amri I, Leong DP, et al. Leaflet remodelling in functional mitral valve regurgitation: characteristics, determinants, and relation to regurgitation severity. Eur Heart J Cardiovasc Imaging, 2015, 16(3): 290-299. |
| 26. | Kagiyama N, Hayashida A, Toki M, et al. Insufficient leaflet remodeling in patients with atrial fibrillation: association with the severity of mitral regurgitation. Circ Cardiovasc Imaging, 2017, 10(3): e005451. |
| 27. | Abdelgawad H, Mowafy B, Khidr K, et al. Distinct leaflet-annular remodeling pattern in severe atrial functional mitral regurgitation: a three-dimensional echocardiography study. Egypt Heart J, 2024, 76(1): 77. |
| 28. | Douedi S, Douedi H. Mitral regurgitation//StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. |
| 29. | Izumi C, Eishi K, Ashihara K, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J, 2020, 84(11): 2037-2119. |
| 30. | Naser JA, Alexandrino FB, Harada T, et al. The natural history of atrial functional mitral regurgitation. J Am Coll Cardiol, 2024, 83(16): 1495-1507. |
| 31. | Kang DH, Park SJ, Shin SH, et al. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation. Circulation, 2019, 139(11): 1354-1365. |
| 32. | Waagstein F, Strömblad O, Andersson B, et al. Increased exercise ejection fraction and reversed remodeling after long-term treatment with metoprolol in congestive heart failure: a randomized, stratified, double-blind, placebo-controlled trial in mild to moderate heart failure due to ischemic or idiopathic dilated cardiomyopathy. Eur J Heart Fail, 2003, 5(5): 679-691. |
| 33. | Spinka G, Bartko PE, Heitzinger G, et al. Guideline directed medical therapy and reduction of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging, 2022, 23(6): 755-764. |
| 34. | Anastasiou V, Papazoglou AS, Daios S, et al. Prognostic implications of guideline-directed medical therapy for heart failure in functional mitral regurgitation: a systematic review and meta-analysis. Diagnostics (Basel), 2025, 15(5): 598. |
| 35. | Kim K, Kitai T, Kaji S, et al. Outcomes and predictors of cardiac events in medically treated patients with atrial functional mitral regurgitation. Int J Cardiol, 2020, 316: 195-202. |
| 36. | Saito C, Minami Y, Hagiwara N. Treatment options for the management of atrial functional mitral regurgitation. Heart, 2021, 107(18): 1448-1449. |
| 37. | Wu JT, Zaman JAB, Yakupoglu HY, et al. Catheter ablation of atrial fibrillation in patients with functional mitral regurgitation and left ventricular systolic dysfunction. Front Cardiovasc Med, 2020, 7: 596491. |
| 38. | Masuda M, Sekiya K, Asai M, et al. Influence of catheter ablation for atrial fibrillation on atrial and ventricular functional mitral regurgitation. ESC Heart Fail, 2022, 9(3): 1901-1913. |
| 39. | Chen J, Wang Y, Lv M, et al. Mitral valve repair and surgical ablation for atrial functional mitral regurgitation. Ann Transl Med, 2020, 8(21): 1420. |
| 40. | Song K, Lee JH, Woo HT, et al. Surgical outcome of mitral valve surgery in atrial functional mitral regurgitation compared with degenerative etiology. J Thorac Cardiovasc Surg, 2025, 169(5): 1471-1482. |
| 41. | Hirji SA, Cote CL, Javadikasgari H, et al. Atrial functional versus ventricular functional mitral regurgitation: prognostic implications. J Thorac Cardiovasc Surg, 2022, 164(6): 1808-1815. |
| 42. | Kawamoto N, Fukushima S, Kainuma S, et al. Mitral valve surgery for atrial functional mitral regurgitation: predicting recurrent mitral regurgitation and mid-term outcome. Gen Thorac Cardiovasc Surg, 2022, 70(9): 761-769. |
| 43. | Carino D, Lapenna E, Ascione G, et al. Is mitral annuloplasty an effective treatment for severe atrial functional mitral regurgitation?. J Card Surg, 2021, 36(2): 596-602. |
| 44. | Deferm S, Bertrand PB, Verhaert D, et al. Outcome and durability of mitral valve annuloplasty in atrial secondary mitral regurgitation. Heart, 2021, 107(18): 1503-1509. |
| 45. | Matsumori M, Kawashima M, Aihara T, et al. Efficacy of left atrial plication for atrial functional mitral regurgitation. Gen Thorac Cardiovasc Surg, 2021, 69(3): 458-465. |
| 46. | Nakamae K, Oshitomi T, Uesugi H, et al. Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation. Indian J Thorac Cardiovasc Surg, 2024, 40(1): 24-32. |
| 47. | Takahashi Y, Morisaki A, Sakon Y, et al. Additional left atrial plication improves postoperative cardiovascular events in atrial functional mitral regurgitation. J Thorac Dis, 2024, 16(9): 5494-5506. |
| 48. | Tanaka T, Sugiura A, Öztürk C, et al. Transcatheter edge-to-edge repair for atrial secondary mitral regurgitation. JACC Cardiovasc Interv, 2022, 15(17): 1731-1740. |
| 49. | Doldi P, Stolz L, Orban M, et al. Transcatheter mitral valve repair in patients with atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2022, 15(11): 1843-1851. |
| 50. | Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, et al. Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation. Int J Cardiol, 2021, 345: 29-35. |
| 51. | Hamada S, Ueyama H, Aikawa T, et al. Outcomes of transcatheter edge-to-edge repair for atrial functional mitral regurgitation: a meta-analysis of observational studies. Catheter Cardiovasc Interv, 2023, 102(4): 751-760. |
| 52. | Cheng R, Dawkins S, Tat E, et al. Relation of residual mitral regurgitation despite elevated mitral gradients to risk of heart failure hospitalization after mitraclip repair. Am J Cardiol, 2017, 120(9): 1595-1600. |
| 53. | Yoshida J, Ikenaga H, Nagaura T, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J, 2021, 85(7): 1001-1010. |
| 54. | Nagaura T, Hayashi A, Yoshida J, et al. Percutaneous edge-to-edge repair for atrial functional mitral regurgitation: a real-time 3-dimensional transesophageal echocardiography study. JACC Cardiovasc Imaging, 2019, 12(9): 1881-1883. |
| 55. | Yoon SH, Makar M, Kar S, et al. Outcomes after transcatheter edge-to-edge mitral valve repair according to mitral regurgitation etiology and cardiac remodeling. JACC Cardiovasc Interv, 2022, 15(17): 1711-1722. |
| 56. | von Stein P, von Stein J, Hohmann C, et al. Atrial functional mitral regurgitation subtypes undergoing transcatheter edge-to-edge repair: suboptimal outcomes in atriogenic hamstringing. JACC Cardiovasc Imaging, 2025, 18(1): 16-29. |
| 57. | Kagiyama N, Kaneko T, Amano M, et al. Clinical outcomes of mitral valve surgery in atrial functional mitral regurgitation in the REVEAL-AFMR Registry. JAMA Netw Open, 2024, 7(8): e2428032. |
| 58. | Fan X, Tang Y, Ma Y, et al. Mitral valve repair and concomitant maze procedure versus catheter ablation in the treatment of atrial functional mitral regurgitation. BMC Cardiovasc Disord, 2022, 22(1): 543. |
| 59. | Rottländer D, Golabkesh M, Degen H, et al. Mitral valve edge-to-edge repair versus indirect mitral valve annuloplasty in atrial functional mitral regurgitation. Catheter Cardiovasc Interv, 2022, 99(6): 1839-1847. |
- 1. Kumanohoso T, Otsuji Y, Yoshifuku S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg, 2003, 125(1): 135-143.
- 2. Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol, 2011, 58(14): 1474-1481.
- 3. Farhan S, Silbiger JJ, Halperin JL, et al. Pathophysiology, echocardiographic diagnosis, and treatment of atrial functional mitral regurgitation: JACC state-of-the-art review. J Am Coll Cardiol, 2022, 80(24): 2314-2330.
- 4. Chen QF, Zhou X, Katsouras CS, et al. Atrial and ventricular functional mitral regurgitation: prevalence, characteristics, outcomes, and disease progression. Eur Heart J Cardiovasc Imaging, 2025, 26(3): 545-556.
- 5. Levy MJ, Edwards JE. Anatomy of mitral insufficiency. Prog Cardiovasc Dis, 1962, 5: 119-144.
- 6. Tanimoto M, Pai RG. Effect of isolated left atrial enlargement on mitral annular size and valve competence. Am J Cardiol, 1996, 77(9): 769-774.
- 7. Henry WL, Morganroth J, Pearlman AS, et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation, 1976, 53(2): 273-279.
- 8. Wozakowska-Kapłon B. Changes in left atrial size in patients with persistent atrial fibrillation: a prospective echocardiographic study with a 5-year follow-up period. Int J Cardiol, 2005, 101(1): 47-52.
- 9. Vaziri SM, Larson MG, Benjamin EJ, et al. Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study. Circulation, 1994, 89(2): 724-730.
- 10. Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol, 2002, 39(10): 1651-1656.
- 11. Borlaug BA. The pathophysiology of heart failure with preserved ejection fraction. Nat Rev Cardiol, 2014, 11(9): 507-515.
- 12. Tamargo M, Obokata M, Reddy YNV, et al. Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail, 2020, 22(3): 489-498.
- 13. Reddy YNV, Obokata M, Verbrugge FH, et al. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Am Coll Cardiol, 2020, 76(9): 1051-1064.
- 14. Salgo IS, Gorman JH, Gorman RC, et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation, 2002, 106(6): 711-717.
- 15. Bai W, Chen Y, Zhong Y, et al. Assessment of mitral valve geometry in nonvalvular atrial fibrillation patients with or without ventricular dysfunction: insights from high volume rate three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging, 2023, 39(12): 2427-2436.
- 16. Cong T, Gu J, Lee AP, et al. Quantitative analysis of mitral valve morphology in atrial functional mitral regurgitation using real-time 3-dimensional echocardiography atrial functional mitral regurgitation. Cardiovasc Ultrasound, 2018, 16(1): 13.
- 17. Kim DH, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2019, 12(4): 665-677.
- 18. Silbiger JJ. Anatomy, mechanics, and pathophysiology of the mitral annulus. Am Heart J, 2012, 164(2): 163-176.
- 19. Silbiger JJ, Bazaz R. The anatomic substrate of mitral annular contraction. Int J Cardiol, 2020, 306: 158-161.
- 20. Deferm S, Bertrand PB, Verhaert D, et al. Mitral annular dynamics in AF versus sinus rhythm: novel insights into the mechanism of AFMR. JACC Cardiovasc Imaging, 2022, 15(1): 1-13.
- 21. Silbiger JJ. Does left atrial enlargement contribute to mitral leaflet tethering in patients with functional mitral regurgitation? Proposed role of atriogenic leaflet tethering. Echocardiography, 2014, 31(10): 1310-1311.
- 22. Machino-Ohtsuka T, Seo Y, Ishizu T, et al. Novel mechanistic insights into atrial functional mitral regurgitation - 3-dimensional echocardiographic study. Circ J, 2016, 80(10): 2240-2248.
- 23. Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, et al. Tricuspid and mitral remodelling in atrial fibrillation: a three-dimensional echocardiographic study. Eur Heart J Cardiovasc Imaging, 2022, 23(7): 944-955.
- 24. Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation, 2008, 118(8): 845-852.
- 25. Debonnaire P, Al Amri I, Leong DP, et al. Leaflet remodelling in functional mitral valve regurgitation: characteristics, determinants, and relation to regurgitation severity. Eur Heart J Cardiovasc Imaging, 2015, 16(3): 290-299.
- 26. Kagiyama N, Hayashida A, Toki M, et al. Insufficient leaflet remodeling in patients with atrial fibrillation: association with the severity of mitral regurgitation. Circ Cardiovasc Imaging, 2017, 10(3): e005451.
- 27. Abdelgawad H, Mowafy B, Khidr K, et al. Distinct leaflet-annular remodeling pattern in severe atrial functional mitral regurgitation: a three-dimensional echocardiography study. Egypt Heart J, 2024, 76(1): 77.
- 28. Douedi S, Douedi H. Mitral regurgitation//StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.
- 29. Izumi C, Eishi K, Ashihara K, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J, 2020, 84(11): 2037-2119.
- 30. Naser JA, Alexandrino FB, Harada T, et al. The natural history of atrial functional mitral regurgitation. J Am Coll Cardiol, 2024, 83(16): 1495-1507.
- 31. Kang DH, Park SJ, Shin SH, et al. Angiotensin receptor neprilysin inhibitor for functional mitral regurgitation. Circulation, 2019, 139(11): 1354-1365.
- 32. Waagstein F, Strömblad O, Andersson B, et al. Increased exercise ejection fraction and reversed remodeling after long-term treatment with metoprolol in congestive heart failure: a randomized, stratified, double-blind, placebo-controlled trial in mild to moderate heart failure due to ischemic or idiopathic dilated cardiomyopathy. Eur J Heart Fail, 2003, 5(5): 679-691.
- 33. Spinka G, Bartko PE, Heitzinger G, et al. Guideline directed medical therapy and reduction of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging, 2022, 23(6): 755-764.
- 34. Anastasiou V, Papazoglou AS, Daios S, et al. Prognostic implications of guideline-directed medical therapy for heart failure in functional mitral regurgitation: a systematic review and meta-analysis. Diagnostics (Basel), 2025, 15(5): 598.
- 35. Kim K, Kitai T, Kaji S, et al. Outcomes and predictors of cardiac events in medically treated patients with atrial functional mitral regurgitation. Int J Cardiol, 2020, 316: 195-202.
- 36. Saito C, Minami Y, Hagiwara N. Treatment options for the management of atrial functional mitral regurgitation. Heart, 2021, 107(18): 1448-1449.
- 37. Wu JT, Zaman JAB, Yakupoglu HY, et al. Catheter ablation of atrial fibrillation in patients with functional mitral regurgitation and left ventricular systolic dysfunction. Front Cardiovasc Med, 2020, 7: 596491.
- 38. Masuda M, Sekiya K, Asai M, et al. Influence of catheter ablation for atrial fibrillation on atrial and ventricular functional mitral regurgitation. ESC Heart Fail, 2022, 9(3): 1901-1913.
- 39. Chen J, Wang Y, Lv M, et al. Mitral valve repair and surgical ablation for atrial functional mitral regurgitation. Ann Transl Med, 2020, 8(21): 1420.
- 40. Song K, Lee JH, Woo HT, et al. Surgical outcome of mitral valve surgery in atrial functional mitral regurgitation compared with degenerative etiology. J Thorac Cardiovasc Surg, 2025, 169(5): 1471-1482.
- 41. Hirji SA, Cote CL, Javadikasgari H, et al. Atrial functional versus ventricular functional mitral regurgitation: prognostic implications. J Thorac Cardiovasc Surg, 2022, 164(6): 1808-1815.
- 42. Kawamoto N, Fukushima S, Kainuma S, et al. Mitral valve surgery for atrial functional mitral regurgitation: predicting recurrent mitral regurgitation and mid-term outcome. Gen Thorac Cardiovasc Surg, 2022, 70(9): 761-769.
- 43. Carino D, Lapenna E, Ascione G, et al. Is mitral annuloplasty an effective treatment for severe atrial functional mitral regurgitation?. J Card Surg, 2021, 36(2): 596-602.
- 44. Deferm S, Bertrand PB, Verhaert D, et al. Outcome and durability of mitral valve annuloplasty in atrial secondary mitral regurgitation. Heart, 2021, 107(18): 1503-1509.
- 45. Matsumori M, Kawashima M, Aihara T, et al. Efficacy of left atrial plication for atrial functional mitral regurgitation. Gen Thorac Cardiovasc Surg, 2021, 69(3): 458-465.
- 46. Nakamae K, Oshitomi T, Uesugi H, et al. Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation. Indian J Thorac Cardiovasc Surg, 2024, 40(1): 24-32.
- 47. Takahashi Y, Morisaki A, Sakon Y, et al. Additional left atrial plication improves postoperative cardiovascular events in atrial functional mitral regurgitation. J Thorac Dis, 2024, 16(9): 5494-5506.
- 48. Tanaka T, Sugiura A, Öztürk C, et al. Transcatheter edge-to-edge repair for atrial secondary mitral regurgitation. JACC Cardiovasc Interv, 2022, 15(17): 1731-1740.
- 49. Doldi P, Stolz L, Orban M, et al. Transcatheter mitral valve repair in patients with atrial functional mitral regurgitation. JACC Cardiovasc Imaging, 2022, 15(11): 1843-1851.
- 50. Benito-González T, Carrasco-Chinchilla F, Estévez-Loureiro R, et al. Clinical and echocardiographic outcomes of transcatheter mitral valve repair in atrial functional mitral regurgitation. Int J Cardiol, 2021, 345: 29-35.
- 51. Hamada S, Ueyama H, Aikawa T, et al. Outcomes of transcatheter edge-to-edge repair for atrial functional mitral regurgitation: a meta-analysis of observational studies. Catheter Cardiovasc Interv, 2023, 102(4): 751-760.
- 52. Cheng R, Dawkins S, Tat E, et al. Relation of residual mitral regurgitation despite elevated mitral gradients to risk of heart failure hospitalization after mitraclip repair. Am J Cardiol, 2017, 120(9): 1595-1600.
- 53. Yoshida J, Ikenaga H, Nagaura T, et al. Impact of percutaneous edge-to-edge repair in patients with atrial functional mitral regurgitation. Circ J, 2021, 85(7): 1001-1010.
- 54. Nagaura T, Hayashi A, Yoshida J, et al. Percutaneous edge-to-edge repair for atrial functional mitral regurgitation: a real-time 3-dimensional transesophageal echocardiography study. JACC Cardiovasc Imaging, 2019, 12(9): 1881-1883.
- 55. Yoon SH, Makar M, Kar S, et al. Outcomes after transcatheter edge-to-edge mitral valve repair according to mitral regurgitation etiology and cardiac remodeling. JACC Cardiovasc Interv, 2022, 15(17): 1711-1722.
- 56. von Stein P, von Stein J, Hohmann C, et al. Atrial functional mitral regurgitation subtypes undergoing transcatheter edge-to-edge repair: suboptimal outcomes in atriogenic hamstringing. JACC Cardiovasc Imaging, 2025, 18(1): 16-29.
- 57. Kagiyama N, Kaneko T, Amano M, et al. Clinical outcomes of mitral valve surgery in atrial functional mitral regurgitation in the REVEAL-AFMR Registry. JAMA Netw Open, 2024, 7(8): e2428032.
- 58. Fan X, Tang Y, Ma Y, et al. Mitral valve repair and concomitant maze procedure versus catheter ablation in the treatment of atrial functional mitral regurgitation. BMC Cardiovasc Disord, 2022, 22(1): 543.
- 59. Rottländer D, Golabkesh M, Degen H, et al. Mitral valve edge-to-edge repair versus indirect mitral valve annuloplasty in atrial functional mitral regurgitation. Catheter Cardiovasc Interv, 2022, 99(6): 1839-1847.