Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium.
J Am Coll Cardiol. 2019 May 21;73(19):2465-2476. doi: 10.1016/j.jacc.2019.02.061.
Unlike secondary mitral regurgitation (MR) in the setting of left ventricular (LV) disease, the occurrence of functional MR in atrial fibrillation (AF) and/or heart failure with preserved ejection fraction (HFpEF) has remained largely unspoken. LV size and systolic function are typically normal, whereas isolated mitral annular dilation and inadequate leaflet adaptation are considered mechanistic culprits. Moreover, the role of left atrial and annular dynamics in provoking MR is often underappreciated. Because of this peculiar pathophysiology, atrial functional MR benefits from a different approach compared with secondary MR. Although both AF and HFpEF-two closely related disease epidemics of the 21st century-are held responsible, current guidelines do not emphasize the need to differentiate atrial functional MR from (ventricular) secondary MR. This review summarizes the prevalence and prognostic importance of atrial functional MR, providing mechanistic insights compared with those of secondary MR and suggesting potential therapeutic targets.
不同于左心室（LV）疾病背景下的继发性二尖瓣反流（MR），在心房颤动（AF）和/或射血分数保留的心力衰竭（HFpEF）中发生的功能性 MR 仍然很大程度上未被提及。LV 大小和收缩功能通常正常，而孤立的二尖瓣环扩张和瓣叶适应性不足被认为是机械性罪魁祸首。此外，左心房和瓣环动力学在引发 MR 中的作用往往被低估。由于这种特殊的病理生理学，与继发性 MR 相比，心房功能性 MR 受益于不同的治疗方法。尽管 AF 和 HFpEF——这两种与 21 世纪密切相关的疾病流行——都被认为是罪魁祸首，但目前的指南并没有强调需要区分心房功能性 MR 和（心室）继发性 MR。这篇综述总结了心房功能性 MR 的患病率和预后重要性，与继发性 MR 相比提供了机制上的见解，并提出了潜在的治疗靶点。
