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Does mitral regurgitation reduce the risks of thrombosis in atrial fibrillation and flutter?

Cresti, Albertoa; Galli, Claudia A.b; Alimento, Marina L.b; De Sensi, Francescoa; Baratta, Pasqualea; D’Aiello, Incoronataa; Limbruno, Ugoa; Pepi, Maurob; Fusini, Lauraa; Maltagliati, Anna C.b

Journal of Cardiovascular Medicine: October 2019 - Volume 20 - Issue 10 - p 660–666
doi: 10.2459/JCM.0000000000000838
Research articles: Arrhythmias

Aims Blood stasis is the main cause of left atrial thrombosis (LAT) in atrial tachyarrhythmias. The high-velocity flow inside the left atrium, due to mitral valve regurgitation, may prevent clot formation but the topic has never been investigated in large-scale studies. The aim of our study was to evaluate whether the presence and degree of mitral regurgitation have a protective role against LAT risk.

Methods A total of 1302 consecutive adult patients with paroxysmal or persistent atrial fibrillation or flutter undergoing cardioversion, submitted to transesophageal echocardiography, were retrospectively enrolled in the study. The study population was divided into three groups according to the mitral regurgitation degree: absent, mild-to-moderate and severe.

Results Among 1302 patients enrolled in the study, patients without mitral regurgitation were 248 (19%), those with mild-to-moderate 970 (75%), whereas 84 had severe mitral regurgitation (6%). LAT incidence was significantly lower in patients with severe mitral regurgitation compared with those with mild-to-moderate (mitral regurgitation) (2.4 vs. 8.9%, P < 0.05), and similar to subjects without mitral regurgitation (2.4%).

Conclusion Despite patients with severe regurgitation having clinical and echo characteristics predisposing to LAT (higher age, heart failure, higher atrial size, lower ventricular function) thrombosis prevalence was significantly lower than for those with mild-to-moderate mitral regurgitation. The percentage of LAT in severe mitral regurgitation cases was very low and similar to that of cases without regurgitation which were characterized by lower age, normal left ventricular function or other risk factors, reinforcing the hypothesis of a protecting role against atrial thrombosis of mitral regurgitation.

aCardioneurovascular Department, Grosseto Hospital, Azienda USL Toscana Sudest

bCentro Cardiologico Monzino IRCCS, Milano, Milano, Italy

Correspondence to Ugo Limbruno, MD, Cardiological Department, Misericordia Hospital, Via Senese, 58100 Grosseto, Italy E-mail:

Received 26 March, 2019

Revised 1 May, 2019

Accepted 1 July, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.