Factors Associated With and Prognosis of Atriogenic Tethering in Patients With Atrial Functional Mitral Regurgitation
Abstract
BACKGROUND: Atriogenic tethering (AT) is a characteristic feature of the mitral valve in atrial functional mitral regurgitation (AFMR). However, the factors associated with AT are not well known. METHODS AND RESULTS: This was a post hoc analysis of REVEAL-AFMR, a retrospective observational study involving patients with moderate or greater AFMR. A stepwise binary logistic regression model was used to identify factors associated with AT. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, and mitral valve intervention. Of 1,007 patients, 245 (24%) had AT and 762 (76%) did not. Of 15 clinical variables related to AT in AFMR, greater left ventricular end-systolic dimension and left atrial diameter were independently associated with AT. The 3-year rate of freedom from the primary outcome was significantly lower in the group with than without AT (63.2% vs. 71.2%; P=0.002). The risk of the primary outcome was significantly higher in the group with than without AT (adjusted hazard ratio 1.34; 95% confidence interval 1.04-1.74; P=0.026), although the results were inconsistent in the sensitivity analysis using propensity score overlap weighting. CONCLUSIONS: AT was identified in 24% of patients with moderate or greater AFMR. Greater left ventricular end-systolic and left atrial anteroposterior dimensions were factors associated with AT. Among patients with AFMR, those with AT showed a poor prognosis.
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BibTeX
@article{omori2026factors,
title = {{Factors Associated With and Prognosis of Atriogenic Tethering in Patients With Atrial Functional Mitral Regurgitation}},
author = {Nami Omori and Masashi Amano and Tomohiro Kaneko and Yukio Sato and Yohei Ohno and Masaru Obokata and Kimi Sato and Taiji Okada and Kojiro Morita and Tomoko Machino-Ohtsuka and Yukio Abe and Chisato Izumi and Nobuyuki Kagiyama},
journal = {Circulation Journal},
year = {2026},
month = aug,
doi = {10.1253/circj.cj-25-0465},
url = {https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-25-0465/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Factors Associated With and Prognosis of Atriogenic Tethering in Patients With Atrial Functional Mitral Regurgitation
AU - Nami Omori
AU - Masashi Amano
AU - Tomohiro Kaneko
AU - Yukio Sato
AU - Yohei Ohno
AU - Masaru Obokata
AU - Kimi Sato
AU - Taiji Okada
AU - Kojiro Morita
AU - Tomoko Machino-Ohtsuka
AU - Yukio Abe
AU - Chisato Izumi
AU - Nobuyuki Kagiyama
PY - 2026
DA - 2026/08/25
JO - Circulation Journal
DO - 10.1253/circj.cj-25-0465
UR - https://www.jstage.jst.go.jp/article/circj/90/9/90_CJ-25-0465/_article
AB - BACKGROUND: Atriogenic tethering (AT) is a characteristic feature of the mitral valve in atrial functional mitral regurgitation (AFMR). However, the factors associated with AT are not well known. METHODS AND RESULTS: This was a post hoc analysis of REVEAL-AFMR, a retrospective observational study involving patients with moderate or greater AFMR. A stepwise binary logistic regression model was used to identify factors associated with AT. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, and mitral valve intervention. Of 1,007 patients, 245 (24%) had AT and 762 (76%) did not. Of 15 clinical variables related to AT in AFMR, greater left ventricular end-systolic dimension and left atrial diameter were independently associated with AT. The 3-year rate of freedom from the primary outcome was significantly lower in the group with than without AT (63.2% vs. 71.2%; P=0.002). The risk of the primary outcome was significantly higher in the group with than without AT (adjusted hazard ratio 1.34; 95% confidence interval 1.04-1.74; P=0.026), although the results were inconsistent in the sensitivity analysis using propensity score overlap weighting. CONCLUSIONS: AT was identified in 24% of patients with moderate or greater AFMR. Greater left ventricular end-systolic and left atrial anteroposterior dimensions were factors associated with AT. Among patients with AFMR, those with AT showed a poor prognosis.
SN - 1347-4820
SN - 1346-9843
ER -