Centre Hospitalier Régional et Universitaire de Lille, Department of Ultrasound and Physiology, Lille, France.
Heart. 2010 Feb;96(4):289-97. doi: 10.1136/hrt.2009.177014.
Functional mitral regurgitation (FMR) may occur in patients with reduced or preserved left ventricular ejection fraction (LVEF) and has been associated with excess valvular tenting only in patients with reduced LVEF. This study aimed at identifying the predictors of FMR and to determine whether or not they are different in patients with reduced versus preserved LVEF.
190 consecutive patients free of congenital or primary valvular disease had a comprehensive echocardiographic assessment of LV remodelling and function, diastolic function and FMR severity.
112 patients had depressed LVEF (<50%) and 78 had preserved LVEF. FMR was present in 30 patients with preserved LVEF and in 65 with reduced LVEF. Higher E/Ea, E/A and larger mitral tenting were independent predictors of FMR regardless of LVEF. The mitral tenting area was an independent predictor of FMR severity in patients with reduced or preserved LVEF (p = 0.04 and p = 0.0045) in addition to E/A (p = 0.0007), E/Ea (p = 0.004) in patients with reduced and preserved LVEF, respectively. Higher E/Ea was independently associated with larger mitral tenting in patients with reduced and preserved LVEF. Mitral tenting area was linearly related to E/Ea (r = 0.30, p<0.0001) and E/A (r = 0.43, p<0.0001) and LA enlargement (r = 0.54, p<0.0001) after having paired 96 patients with and without FMR on indices of LV remodelling.
In both patients with preserved and reduced LVEF, mitral tenting that leads to FMR is mainly determined by both mitral tethering forces-that is, displacement of papillary muscles and by pushing forces-that is, increased left atrial pressure. This study underscores that LV preload is a key determinant of FMR.
功能性二尖瓣反流（FMR）可能发生在左心室射血分数（LVEF）降低或保留的患者中，并且仅在 LVEF 降低的患者中与瓣叶过度张开相关。本研究旨在确定 FMR 的预测因素，并确定它们在 LVEF 降低与保留的患者中是否不同。
190 例连续无先天性或原发性瓣膜疾病的患者进行了全面的超声心动图评估，包括 LV 重塑和功能、舒张功能和 FMR 严重程度。
112 例患者 LVEF 降低（<50%），78 例患者 LVEF 保留。78 例保留 LVEF 的患者中有 30 例存在 FMR，65 例 LVEF 降低的患者中有 65 例存在 FMR。E/Ea、E/A 和更大的二尖瓣张开是 FMR 的独立预测因素，无论 LVEF 如何。在保留和降低 LVEF 的患者中，二尖瓣张开面积是 FMR 严重程度的独立预测因素（p=0.04 和 p=0.0045），此外 E/A（p=0.0007）、E/Ea（p=0.004）分别在降低和保留 LVEF 的患者中。在降低和保留 LVEF 的患者中，较高的 E/Ea 与更大的二尖瓣张开独立相关。二尖瓣张开面积与 E/Ea（r=0.30，p<0.0001）和 E/A（r=0.43，p<0.0001）以及 LA 扩大（r=0.54，p<0.0001）呈线性相关，在对 96 例有和无 FMR 的患者进行配对后，对 LV 重塑的各项指标进行了评估。
在保留和降低 LVEF 的患者中，导致 FMR 的二尖瓣张开主要由二尖瓣的牵制力（即乳头肌的位移）和推动力（即左心房压力的增加）决定。本研究强调了 LV 前负荷是 FMR 的关键决定因素。
