Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada.
J Thorac Cardiovasc Surg. 2022 Dec;164(6):1808-1815.e4. doi: 10.1016/j.jtcvs.2020.12.098. Epub 2020 Dec 31.
Atrial functional mitral regurgitation (FMR) occurs because of left atrial dilatation or atrial fibrillation in heart failure with preserved left ventricular (LV) function, contrary to ventricular FMR, which occurs because of LV dysfunction. Despite pathophysiological differences, current guidelines do not discriminate between these 2 entities.
From January 2002 to March 2019, all adult patients with ≥3+ mitral regurgitation who underwent mitral valve repair or replacement were identified. Postoperative outcomes and midterm time-to-event rates (survival and reoperation) were compared.
Overall, 94 atrial FMR (mean age, 67.6 years) and 84 ventricular FMR (mean age, 64 years) patients met inclusion criteria. Differences in baseline cardiac morphology and function of the atrial FMR and ventricular FMR patients were as follows: concomitant atrial fibrillation (37.2% vs 14.3%), heart failure (42.6% vs 63.1%), LV ejection fraction (60% vs 37%), at least moderate LV dilation (4.8% vs 40.6%), and moderate/severe right heart dysfunction (15.2% vs 5.1%), respectively. Operative mortality was 0% in the atrial FMR versus 1.2% in the ventricular FMR cohort. Actuarial estimates of survival and freedom from reoperation at 5 and 10 years was significantly higher in the atrial FMR cohort versus the ventricular FMR cohort. Ventricular FMR also remained a significant predictor of midterm mortality in our risk-adjusted analysis (adjusted hazard ratio for ventricular FMR, 1.8; 95% confidence interval, 1.001-3.26).
There are important differences in baseline characteristics in terms of cardiac morphology and function among atrial FMR and ventricular FMR patients, which appear to affect in-hospital and midterm outcomes. Because of these discrepancies, early discrimination between these 2 etiologies of FMR might facilitate more tailored approaches to management.
与因左心室（LV）功能障碍而发生的室性功能性二尖瓣反流（FMR）不同，左心房扩张或心房颤动导致的保留左心室功能的心力衰竭患者会发生房性 FMR。尽管存在病理生理学差异，但现行指南并未对这两种情况加以区分。
从 2002 年 1 月至 2019 年 3 月，共纳入了 94 例二尖瓣反流≥3+级且接受了二尖瓣修复或置换的成年患者。比较了术后结局和中期时间事件（生存和再次手术）发生率。
共有 94 例房性 FMR（平均年龄 67.6 岁）和 84 例室性 FMR（平均年龄 64 岁）患者符合纳入标准。房性 FMR 和室性 FMR 患者的基线心脏形态和功能存在以下差异：伴发心房颤动（37.2% vs. 14.3%）、心力衰竭（42.6% vs. 63.1%）、LV 射血分数（60% vs. 37%）、至少中度 LV 扩张（4.8% vs. 40.6%）和中重度右心功能障碍（15.2% vs. 5.1%）。房性 FMR 组的手术死亡率为 0%，而室性 FMR 组为 1.2%。在 5 年和 10 年时，房性 FMR 组的生存和免于再次手术的累积估计率明显高于室性 FMR 组。在我们的风险调整分析中，室性 FMR 仍然是中期死亡率的显著预测因素（室性 FMR 的调整后危险比为 1.8；95%置信区间，1.001-3.26）。
房性 FMR 和室性 FMR 患者在心脏形态和功能方面存在重要的基线特征差异，这些差异似乎会影响住院和中期结局。由于这些差异，早期区分这两种 FMR 病因可能有助于更有针对性地管理。
