Quanto pior a diástole, pior o refluxo mitral.

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Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: Data from the Acorn trial.
Am Heart J Volume 157(4), April 2009, p 762e3–762e10
Park, Seong-Mi MDa; Park, Seung Woo MDb; Casaclang-Verzosa, Grace MDc; Ommen, Steve R. MDc; Pellikka, Patricia A. MDc; Miller, Fletcher A. Jr. MDc; Sarano, Maurice E. MDc; Kubo, Spencer H. MDd; Oh, Jae K. MDc,*
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"These findings suggest that LA enlargement caused by advanced diastolic dysfunction may contribute to causing significant MR by augmenting mitral annular dilatation in DCM"
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The severity of functional MR in this patient cohort was correlated most significantly with the mitral valvular tenting area, which was in turn more closely related to mitral annular size and diastolic dysfunction severity than to LV volume. Diastolic dysfunction, therefore, appears to be an important contributing factor for development of MR in patients with DCM, probably by causing enlarging of the LA volume and the mitral annulus and subsequent augmenting of the tenting area.
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