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 Cardiol. 2021 Jun;77(6):565-569. doi: 10.1016/j.jjcc.2020.12.002. Epub 2020 Dec 19.
Functional mitral regurgitation (MR) has been traditionally known as secondary MR resulting from left ventricular (LV) dilatation and systolic dysfunction. However, deterioration of functional MR also relates to mitral annular (MA) dilatation. Furthermore, MA dilatation due to left atrial dilatation in patients with atrial fibrillation (AF) can also cause functional MR, even in the absence of LV systolic dysfunction, in a condition referred to as "atrial functional MR" (AFMR). AFMR also has other etiological factors, including disruption of the MA saddle shape, reduction in MA contractility, inadequate compensation for the MA dilatation resulting from the lack of leaflet remodeling, and hamstringing of the posterior mitral leaflet by atriogenic tethering. AFMR 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. The traditional functional MR occurring in patients with LV dilatation and systolic dysfunction has since been designated "ventricular functional MR" (VFMR) to distinguish it from AFMR. This review article compares the current perceptions of newly recognized AFMR with those of traditional VFMR.
功能性二尖瓣反流（MR）传统上被认为是继发于左心室（LV）扩张和收缩功能障碍的 MR。然而，功能性 MR 的恶化也与二尖瓣环（MA）扩张有关。此外，在心房颤动（AF）患者中，由于左心房扩张导致的 MA 扩张也可引起功能性 MR，即使在没有 LV 收缩功能障碍的情况下，这种情况被称为“心房功能性 MR”（AFMR）。AFMR 还有其他病因因素，包括 MA 鞍形破坏、MA 收缩力降低、由于瓣叶重塑缺乏导致的 MA 扩张代偿不足，以及由心源性牵拉导致的后二尖瓣叶受限。AFMR 最近作为心力衰竭的一个重要病因受到了广泛关注，它是 AF 心力衰竭患者的一个重要治疗靶点。传统的发生于 LV 扩张和收缩功能障碍患者的功能性 MR 现在被指定为“心室功能性 MR”（VFMR），以与 AFMR 相区别。本文综述了对新认识的 AFMR 和传统的 VFMR 的当前认识。
