Bartko Philipp E, Hülsmann Martin, Hung Judy, Pavo Noemi, Levine Robert A, Pibarot Philippe, Vahanian Alec, Stone Gregg W, Goliasch Georg
Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA.
Eur Heart J. 2020 Aug 1;41(29):2799-2810. doi: 10.1093/eurheartj/ehaa129.
Secondary mitral regurgitation and secondary tricuspid regurgitation due to heart failure (HF) remain challenging in almost every aspect: increasing prevalence, poor prognosis, notoriously elusive in diagnosis, and complexity of therapeutic management. Recently, defined HF subgroups according to three ejection fraction (EF) ranges (reduced, mid-range, and preserved) have stimulated a structured understanding of the HF syndrome but the role of secondary valve regurgitation (SVR) across the spectrum of EF remains undefined. This review expands this structured understanding by consolidating the underlying phenotype of myocardial impairment with each type of SVR. Specifically, the current understanding, epidemiological considerations, impact, public health burden, mechanisms, and treatment options of SVR are discussed separately for each lesion across the HF spectrum. Furthermore, this review identifies important gaps in knowledge, future directions for research, and provides potential solutions for diagnosis and treatment. Mastering the challenge of SVR requires a multidisciplinary collaborative effort, both, in clinical practice and scientific approach to optimize patient outcomes.
由心力衰竭（HF）引起的继发性二尖瓣反流和继发性三尖瓣反流在几乎各个方面都仍然具有挑战性：患病率不断上升、预后不良、诊断 notoriously elusive、治疗管理复杂。最近，根据三个射血分数（EF）范围（降低、中等范围和保留）定义的HF亚组激发了对HF综合征的结构化理解，但EF范围内继发性瓣膜反流（SVR）的作用仍不明确。本综述通过整合心肌损伤的潜在表型与每种类型的SVR来扩展这种结构化理解。具体而言，针对HF范围内的每个病变，分别讨论了SVR的当前理解、流行病学考量、影响、公共卫生负担、机制和治疗选择。此外，本综述确定了知识上的重要差距、未来的研究方向，并提供了诊断和治疗的潜在解决方案。在临床实践和科学方法中，掌握SVR的挑战需要多学科的协作努力，以优化患者预后。
