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Introduction: Mitral regurgitation (MR) is a common valvular abnormality that can be exacerbated by atrial fibrillation (AF). Mitral regurgitation is classified based on mitral leaflet motion and can be either primary (organic) or secondary (functional). This study investigates the relationship between AF and functional MR, specifically assessing whether cardioversion to sinus rhythm influences MR severity and echocardiographic indices., Methods: This retrospective cohort study included 417 patients with AF and significant MR (Grade III or IV) who were hospitalized for cardioversion. Patients underwent echocardiography during AF and again within six months after successful cardioversion. The primary outcome was the change in MR severity post cardioversion. Secondary outcomes included changes in left atrial size, left ventricular ejection fraction, and mitral valve anatomy. Statistical analysis involved chi-square tests for categorical variables, Student's t-tests for continuous variables, and multivariate logistic regression to assess the impact of sinus rhythm restoration on MR severity., Results: Of the 417 patients, 61% (n = 254) returned to sinus rhythm after cardioversion. Among these, 28.4% (n = 72) showed a two-grade or greater improvement in MR severity. Patients who returned to sinus rhythm also exhibited significant reductions in left ventricular and left atrial dimensions and improved transvalvular gradients. The multivariate analysis indicated that conversion to sinus rhythm was independently associated with MR improvement., Conclusions: Restoration of sinus rhythm is associated with significant improvement in functional MR, potentially reducing the need for surgical intervention. These findings suggest that rhythm control should be considered in managing patients with AF and significant MR, as it may lead to improved cardiac function and better clinical outcomes. Further large-scale prospective studies are needed to determine the most effective management strategy for functional MR in the context of AF., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mtour et al.)

Background: Takotsubo cardiomyopathy (TC) is a transient cardiac syndrome that manifests with symptoms resembling acute myocardial infarction (MI). It is characterized by temporary wall-motion abnormalities predominantly affecting the apical and mid-portions of the left ventricle, despite the absence of significant obstructive coronary disease. TC poses diagnostic challenges due to its resemblance to ST-segment elevation myocardial infarction. Our study aimed to determine the prevalence of TC and identify the factors associated with its occurrence in patients presenting with acute MI in Palestine., Results: A retrospective analysis was conducted on a cohort of patients diagnosed with TC at Al-Makassed hospital. Women accounted for 90.7% of TC cases (95% CI 88.2-93.2%). The mean age of affected individuals ranged from 62 to 76 years. The most common presenting symptoms were chest pain (83.4%, 95% CI 80.0-86.7%) and dyspnea (20.4%, 95% CI 16.3-24.5%), often following an emotionally or physically stressful event. Electrocardiography (ECG) on admission indicated ST-segment elevations in 71.1% of cases (95% CI 67.2-75.1%), accompanied by mild elevations of Troponins in 85.0% of cases (95% CI 80.8-89.1%). Despite the initial severity, left ventricular ejection fraction (LVEF) improved from 20-49.9 to 59-76% within a mean time of 7-37 days. The in-hospital mortality rate was 1.7% (95% CI 0.5-2.8%), with complete recovery observed in 95.9% of cases (95% CI 93.8-98.1%) and rare recurrence. The underlying etiology is believed to involve exaggerated sympathetic stimulation., Conclusions: TC should be considered as a significant differential diagnosis in acute coronary syndrome (ACS) cases, particularly among postmenopausal women with a preceding stressful event. Our study provides insights into the prevalence and characteristics of TC in the Palestinian population. While stress has been recognized as a potential trigger for TC, further research is needed to explore if there are specific associations between occupation and other unique stressors in the Palestinian context and the prevalence of TC. The study's results can raise awareness among healthcare professionals in Palestine about the prevalence and characteristics of TC in their patient population., (© 2023. Egyptian Society of Cardiology.)