title: Insufficient Leaflet Remodeling in Patients With Atrial Fibrillation: Association With the Severity of Mitral Regurgitation.
abstract: BACKGROUND
  The relationship between annular dilatation caused by atrial fibrillation (AF) and mitral regurgitation (MR) remains controversial. We hypothesized that the small ratio of total leaflet area/annulus area (TLA/AA), reflecting insufficient leaflet remodeling to annular dilatation, is a main component of MR in patients with AF.
  
  
  RESULTS
  Three-dimensional transesophageal echocardiographic data of the mitral valve were analyzed in 28 AF patients with moderate or severe MR (MR group), age- and sex-matched 56 AF patients with mild or less MR (non-MR group), and 16 control subjects. AA was significantly greater in both the MR (645±126 mm2/m2,P<0.001) and non-MR groups (568±121 mm2/m2,P=0.001) compared with control subjects (444±108 mm2/m2). However, TLA/AA was significantly smaller in the MR (1.29±0.10,P<0.001), but not in the non-MR group (1.65±0.24,P>0.99), compared with control subjects (1.70±0.29). In linear regression analysis, TLA/AA was inversely associated with the effective regurgitant orifice (r=-0.73,P<0.001). The area under the receiver-operating-characteristics curve of TLA/AA was significantly greater than that of AA (0.95 versus 0.72,P<0.001). Multivariable analysis revealed that small TLA/AA (P<0.001) was independently associated with significant MR, while AA was not (P=0.26).
  
  
  CONCLUSIONS
  In patients with AF, insufficient leaflet remodeling to annular dilatation, rather than crude annular dilatation, was strongly associated with the severity of MR.
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.). kgnb_27_hot@yahoo.co.jp.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kagiyama
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hayashida
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Misako
authors.initials: M
authors.lastname: Toki
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Minako
authors.initials: M
authors.lastname: Ohara
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirohata
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: From the Departments of Cardiology (N.K., A.H., M.O., A.H., K.Y., K.Y.) and Department of Clinical Laboratory (M.T.), The Sakakibara Heart Institute of Okayama, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan (N.K., M.I.); and Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan (S.F.).
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016279:Atrial Function, Left; D064752:Atrial Remodeling; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007564:Japan; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: 3-dimensional echocardiography; atrial fibrillation; dilatation; echocardiography; mitral valve regurgitation