Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Can J Cardiol. 2021 Jul;37(7):968-979. doi: 10.1016/j.cjca.2020.12.011. Epub 2021 May 14.
Ischemic mitral regurgitation (MR) is a valvular complication frequently seen in patients with coronary artery disease and is associated with increased mortality and morbidity. Ischemic mitral regurgitation has a complex, heterogeneous, and still incompletely understood pathophysiology involving both the mitral valve and the left ventricle. The occurrence of valve regurgitation in patients with ischemic cardiomyopathy in return accelerates left ventricular remodelling and dysfunction, ultimately leading to irreversible heart failure. Diagnostic evaluation of ischemic MR is unique and different from the other causes of MR. The severity thresholds associated with outcomes are different from primary MR, and specific imaging characteristics are potentially useful to guide therapy. The use of imaging modalities such as 3-dimensional echocardiography and cardiac magnetic resonance imaging can refine the diagnostic evaluation and help in choosing the correct management. Although multiple treatments are available to improve ischemic MR, each therapeutic option is associated with limitations and incomplete success. Therapy has therefore to be individualised for each patient. Current options include optimal medical therapy, cardiac resynchronisation therapy, percutaneous or surgical revascularisation, surgical mitral repair or replacement, and new percutaneous interventions. This review aims to discuss the latest insights regarding the pathophysiology, diagnosis, and treatment of ischemic MR.
缺血性二尖瓣反流（MR）是冠状动脉疾病患者中经常出现的瓣膜并发症，与死亡率和发病率增加相关。缺血性二尖瓣反流具有复杂、异质且仍不完全理解的病理生理学，涉及二尖瓣和左心室。在缺血性心肌病患者中，瓣膜反流的发生反过来又加速了左心室重构和功能障碍，最终导致不可逆的心力衰竭。缺血性 MR 的诊断评估是独特的，与其他原因的 MR 不同。与结局相关的严重程度阈值与原发性 MR 不同，特定的影像学特征可能有助于指导治疗。使用 3 维超声心动图和心脏磁共振成像等影像学方式可以细化诊断评估，并有助于选择正确的治疗方法。尽管有多种治疗方法可改善缺血性 MR，但每种治疗选择都存在局限性和不完全成功。因此，治疗必须针对每个患者进行个体化。目前的治疗选择包括最佳药物治疗、心脏再同步治疗、经皮或手术血运重建、手术二尖瓣修复或置换以及新的经皮介入治疗。这篇综述旨在讨论缺血性 MR 的病理生理学、诊断和治疗的最新进展。
