Atrial Functional Mitral Regurgitation: A JACC: Cardiovascular Imaging Expert Panel Viewpoint

William A. Zoghbi, Robert A. Levine, Frank Flachskampf, Paul Grayburn, Linda Gillam, Jonathon Leipsic, James D. Thomas, Raymond Y. Kwong, Pieter Vandervoort, Y. Chandrashekhar

Research output: Contribution to journalEditorialpeer-review

25 Scopus citations


Functional or secondary mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality. Mechanistically, secondary MR is attributable to an imbalance between mitral leaflet tethering and closure forces, leading to poor coaptation. The pathophysiology of functional MR is most often the result of abnormalities in left ventricular function and remodeling, seen in ischemic or nonischemic conditions. Less commonly and more recently recognized is the scenario in which left ventricular geometry and function are preserved, the culprit being mitral annular enlargement associated with left atrial dilatation, termed atrial functional mitral regurgitation (AFMR). This most commonly occurs in the setting of chronic atrial fibrillation or heart failure with preserved ejection fraction. There is variability in the published reports and in current investigations as to the definition of AFMR. This paper reviews the pathophysiology of AFMR and focus on the need for a collective definition of AFMR to facilitate consistency in reported data and enhance much-needed research into outcomes and treatment strategies in AFMR.

Original languageEnglish (US)
Pages (from-to)1870-1882
Number of pages13
JournalJACC: Cardiovascular Imaging
Issue number11
StatePublished - Nov 2022


  • atrial fibrillation
  • atrial functional mitral regurgitation
  • functional mitral regurgitation
  • heart failure with preserved ejection fraction
  • ventricular functional mitral regurgitation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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