Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan.
Department of Cardiovascular Surgery, Osaka City University, Osaka, Japan.
J Echocardiogr. 2020 Mar;18(1):1-8. doi: 10.1007/s12574-019-00453-w. Epub 2019 Nov 14.
Lone atrial fibrillation (AF) can cause functional mitral regurgitation (MR), commonly referred to as "atrial functional MR (AFMR)." This type of MR has recently received much attention as an important cause of heart failure, and it represents a considerable therapeutic target in heart failure patients with AF. Mitral annular dilatation due to left atrial (LA) dilatation can be recognized as an original cause of AFMR, whereas the exact cascade of AFMR etiologies has not been established. AFMR is typically classified as Carpentier type I, and is likely to have a central jet. In contrast, a proportion of AFMR is classified as a combination of Carpentier type I for a flattened anterior mitral leaflet and Carpentier type IIIb for a tethered posterior mitral leaflet and is likely to have an eccentric jet directed toward the LA posterior wall. The traditional functional MR occurring in patients with left ventricular (LV) dilatation and/or systolic dysfunction, which is classified as Carpentier type IIIb, has since been designated "ventricular functional MR (VFMR)" to distinguish it from AFMR. Traditional VFMR, newly recognized AFMR, and their etiologic relations to LV/LA size and function are discussed in this review article.
孤立性心房颤动（AF）可导致功能性二尖瓣反流（MR），通常称为“心房功能性 MR（AFMR）”。这种类型的 MR 最近作为心力衰竭的一个重要病因受到了广泛关注，并且它代表了 AF 心力衰竭患者的一个重要治疗靶点。由于左心房（LA）扩张导致的二尖瓣环扩张可被视为 AFMR 的原始病因，而 AFMR 病因的确切级联尚未确定。AFMR 通常被分类为 Carpentier Ⅰ型，很可能有一个中央射流。相比之下，一部分 AFMR 被分类为 Carpentier Ⅰ型的前二尖瓣叶变平，以及 Carpentier Ⅲb 型的后二尖瓣叶被束缚，并可能有一个偏心射流向 LA 后壁。传统的发生在左心室（LV）扩张和/或收缩功能障碍患者中的功能性 MR，被分类为 Carpentier Ⅲb 型，现在被指定为“心室功能性 MR（VFMR）”，以将其与 AFMR 区分开来。本文讨论了传统的 VFMR、新认识的 AFMR 及其与 LV/LA 大小和功能的病因关系。
