Saito Chihiro, Minami Yuichiro, Arai Kotaro, Haruki Shintaro, Yagishita Yoshimi, Jujo Kentaro, Ashihara Kyomi, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
J Cardiol. 2018 Oct;72(4):292-299. doi: 10.1016/j.jjcc.2018.04.002. Epub 2018 May 8.
Functional mitral regurgitation (MR) caused by reduced left ventricular ejection fraction (EF) and tethering, termed ventricular functional MR (VFMR), is associated with worse outcomes. Atrial functional MR (AFMR) caused by left atrial enlargement and annular dilatation was also recently described in patients with atrial fibrillation (AF). However, the clinical profiles of AFMR in hospitalized heart failure (HF) patients are unclear. We investigated the prevalence, clinical characteristics, and prognosis of AFMR in hospitalized HF patients with AF.
We analyzed 189 hospitalized HF patients with AF. The prevalence, clinical characteristics, and prognosis were compared between 4 groups: patients with EF ≥50% and no/mild MR (pEFnoMR), patients with EF <50% and no/mild MR (rEFnoMR), patients with EF ≥50% and moderate/severe MR (AFMR), and patients with EF <50% and moderate/severe MR (VFMR).
The prevalence of AFMR was 15.9% in hospitalized HF patients with AF. AFMR patients were older and more likely to have an enlarged left atrium, lower tenting height, and moderate/severe tricuspid regurgitation than VFMR patients. There were no differences in all-cause death after discharge among pEFnoMR, rEFnoMR, and AFMR patients. AFMR patients were associated with a higher rate of a composite of cardiac death and readmission for HF compared with pEFnoMR and rEFnoMR patients (log-rank p=0.046 and p=0.004). There were no differences in composite endpoints between AFMR and VFMR patients (log-rank p=0.507).
AFMR was present in a proportion of elderly hospitalized HF patients with AF, and was a condition requiring attention because of readmission for HF in a hospitalized HF cohort.
由左心室射血分数（EF）降低和瓣叶牵拉导致的功能性二尖瓣反流（MR），即心室功能性MR（VFMR），与更差的预后相关。近期在心房颤动（AF）患者中也发现了由左心房扩大和瓣环扩张引起的心房功能性MR（AFMR）。然而，住院心力衰竭（HF）患者中AFMR的临床特征尚不清楚。我们调查了住院的合并AF的HF患者中AFMR的患病率、临床特征及预后情况。
我们分析了189例住院的合并AF的HF患者。比较了4组患者的患病率、临床特征及预后：EF≥50%且无/轻度MR的患者（pEFnoMR）、EF<50%且无/轻度MR的患者（rEFnoMR）、EF≥50%且中度/重度MR的患者（AFMR）以及EF<50%且中度/重度MR的患者（VFMR）。
住院的合并AF的HF患者中AFMR的患病率为15.9%。与VFMR患者相比，AFMR患者年龄更大，更易出现左心房扩大、瓣叶帐篷样高度降低及中度/重度三尖瓣反流。pEFnoMR、rEFnoMR和AFMR患者出院后的全因死亡率无差异。与pEFnoMR和rEFnoMR患者相比，AFMR患者发生心源性死亡和HF再入院复合事件的发生率更高（对数秩检验p=0.046和p=0.004）。AFMR和VFMR患者的复合终点无差异（对数秩检验p=0.507）。
一部分老年住院的合并AF的HF患者存在AFMR，因其在住院HF队列中导致HF再入院，所以是一种需要关注的情况。
