MITRAL REGURGITATION REDUCES THE RISK OF STROKE IN PATIENTS WITH NONRHEUMATIC ATRIAL-FIBRILLATION

Background Significant mitral regurgitation (MR) is protective against left atrial (LA) spontaneous echo contrast Formation that is associat ed with an increased thromboembolic risk. However, the effects of MR o n the risk of stroke in patients with nonrheumatic atrial fibrillation (AF) have been unknown. We studied whether or not MR was associated w ith a decreased risk of stroke in patients with nonrheumatic AF. Metho ds We performed an observational analysis of retrospectively collected data on 290 patients with nonrheumatic AF, left atrial diameter (LAD) and the degree of MR were estimated by transthoracic echocardiography . Risk factors for stroke were assessed by multivariate and multivaria te analyses. The mean follow-up was 7.4 years. Results Among these pat ients, 68 had a stroke during the follow-vp (rate of stroke per year o f Follow-vp 3.2%). In 95 patients with LAD of greater than or equal to 48 mm, the incidence of stroke (9%) in the severe MR group (moderate or severe, n = 43) was significantly lower than that (25%) of the mild MR group (none, trivial, or mild; n = 52) (chi-square = 3.95, p = 0.0 47). The relative risk of stroke for increase in MR from mild to sever e groups, For every 10 mm increment in LA size, for sex, and for every increase of 10 years of age was 0.45 (95% CI, 0.20 to 0.97), 1.06 (95 % CI, 0.75 to 1.49), 0.98 (95% CI, 0.55 to 1.72), and 1.33 (95% CI, 1. 04 to 1.71), respectively. Conclusions In patients with nonrheumatic A F, age was an independent predictor of an increased risk of stroke, an d MR may be protective against stroke, especially in those patients wi th LA enlargement.