Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2021-001574.
Atrial functional mitral regurgitation (A-FMR) has been suggested as a new aetiology of functional MR (MR); however, its prognosis and prognostic predictors are not fully elucidated. Aim of this study was to investigate the prognosis and prognostic predictors of A-FMR in comparison with ventricular functional MR (V-FMR).
Three hundred and seventy-eight consecutive patients with moderate-to-severe or severe functional MR were studied. Functional MR was classified into V-FMR (N=288) and A-FMR (N=90) depending on the alterations of left ventricle (LV) or left atrium (LA) along with clinical context and diagnosis of ischaemic heart disease or cardiomyopathy.
During a median follow-up of 4.1 (2.0-6.7) years, all-cause mortality, cardiovascular mortality and heart failure (HF) hospitalisation occurred in 98 (26%), 81 (21%) and 177 (47%) patients, respectively, and rates of these events and the composite end point of all-cause mortality and HF hospitalisation were consistently higher in V-FMR than A-FMR (unadjusted HR 1.762 (95% CI 1.250 to 2.438), p<0.001; adjusted HR 1.654 (95% CI 1.027 to 2.664), p=0.038, for the composite end point). Further analysis showed different prognostic predictors between V-FMR and A-FMR; while age and LA volume index were independent prognostic predictors of both V-FMR and A-FMR, systolic blood pressure and B-type natriuretic peptide were also those of V-FMR, and estimated glomerular filtration rate, LV end-systolic dimension and tricuspid regurgitation were also those of A-FMR.
The prognosis of V-FMR was significantly worse than that of A-FMR, and prognostic predictors were different between V-FMR and A-FMR. Our study suggests the importance of discriminating A-FMR and V-FMR, and that different treatment strategies may be considered for each aetiology.
心房功能性二尖瓣反流（A-FMR）被认为是功能性二尖瓣反流（MR）的一种新病因；然而，其预后和预后预测因素尚未完全阐明。本研究旨在比较心室功能性 MR（V-FMR）探讨 A-FMR 的预后和预后预测因素。
连续纳入 378 例中重度或重度功能性 MR 患者。根据左心室（LV）或左心房（LA）的改变，结合临床情况和缺血性心脏病或心肌病的诊断，将功能性 MR 分为 V-FMR（N=288）和 A-FMR（N=90）。
中位随访 4.1（2.0-6.7）年后，98 例（26%）、81 例（21%）和 177 例（47%）患者发生全因死亡、心血管死亡和心力衰竭（HF）住院，V-FMR 患者上述事件的发生率和全因死亡和 HF 住院的复合终点均明显高于 A-FMR（未调整 HR 1.762（95%CI 1.250 至 2.438），p<0.001；调整 HR 1.654（95%CI 1.027 至 2.664），p=0.038）。进一步分析显示 V-FMR 和 A-FMR 之间存在不同的预后预测因素；虽然年龄和左心房容积指数是 V-FMR 和 A-FMR 的独立预后预测因素，但收缩压和 B 型利钠肽也是 V-FMR 的预测因素，估计肾小球滤过率、LV 收缩末期内径和三尖瓣反流也是 A-FMR 的预测因素。
V-FMR 的预后明显差于 A-FMR，且 V-FMR 和 A-FMR 的预后预测因素不同。本研究表明区分 A-FMR 和 V-FMR 的重要性，对于每种病因可能需要考虑不同的治疗策略。
