From the Division of Cardiology, Weill Cornell Medical College - New York Presbyterian Hospital, New York, NY.
Cardiol Rev. 2019 Nov/Dec;27(6):327-336. doi: 10.1097/CRD.0000000000000269.
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
功能性二尖瓣反流(FMR)在左心室(LV)功能障碍和心力衰竭的情况下预示着预后不良。指南指导的药物治疗仍然是初始治疗的基石,重点是治疗潜在的 LV 功能障碍,因为 FMR 是一种继发性现象,是由 LV 重构引起的疾病。FMR 的手术矫正存在争议,因为它通常不能解决该病症的根本机制和病因。然而,新的、微创的经导管治疗方法,特别是 MitraClip 系统,在治疗选定患者的 FMR 方面显示出了希望。这篇综述将总结 FMR 的病理生理学、心力衰竭和 FMR 患者的预后,以及目前可获得和正在研究的各种药物和程序治疗选择。