This protocol covers the management of severe atrial secondary mitral regurgitation (atrial SMR) in patients with preserved left ventricular ejection fraction (≥50%) who have atrial fibrillation and/or heart failure with preserved ejection fraction (HFpEF).
Atrial SMR in this population is characterised by:
The first-line strategy focuses on optimisation of medical treatment — including rate or rhythm control — with SGLT2 inhibitor therapy specifically recommended for patients with concurrent HFpEF. The complete structured protocol details agent selection and the full management sequence.
DOI: 10.1093/eurheartj/ehaf194
Atrial SMR is most frequently defined by the presence of the following key criteria: preserved LVEF (≥50%) without regional wall motion abnormalities or leaflet tethering; AND clinical criteria (i.e. history of AF and/or diagnosis of HFpEF) are also useful and should be taken into consideration.
The use of SGLT2is should be encouraged in patients with HFpEF due to their proven efficacy in reducing cardiovascular death and HF hospitalization.
Limited data show that rhythm control may contribute to reduce atrial SMR severity and reverse LA dilatation.
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