Division of Cardiology, Cardiovascular Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, Milan 20132, Italy
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Eur Heart J Cardiovasc Imaging. 2016 May;17(5):471-80. doi: 10.1093/ehjci/jev352. Epub 2016 Feb 2.
Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction. Finally, we propose a practical diagnostic and therapeutic strategy for the management of symptomatic patients with severe LV dysfunction and concomitant 'prognostic' FMR.
功能性二尖瓣反流（FMR）是左心室（LV）功能障碍和重构的常见并发症。最近，它已被认为是缺血性和非缺血性 LV 功能障碍的独立预后因素。在这篇综述文章中，我们讨论了心脏不同步通过何种机制参与 FMR 病理生理级联反应，以及心脏再同步治疗（CRT）如何通过逆转特定的不同步途径对 FMR 产生治疗效果。我们分析了最近的临床试验，这些试验集中在 CRT 对“真实世界”患者 FMR 的影响，以及可能最终产生 CRT 反应新预测因子的局限性和未来展望，这些预测因子与 FMR 减少有关。最后，我们提出了一种针对严重 LV 功能障碍和伴发“预后”FMR 的有症状患者的管理的实用诊断和治疗策略。
