Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.
Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
Eur Heart J Cardiovasc Imaging. 2021 Jul 20;22(8):835-843. doi: 10.1093/ehjci/jeab080.
Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into 'proportionate' or 'disproportionate', based on left ventricle (LV) and regurgitant volumes, whereas 'tertiary' MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. We critically discuss the paradigm shift from secondary to tertiary MR and question the notion that MV leaflets play a passive role in secondary MR. We also review the role of standard transthoracic echocardiography for appraising and quantifying maladaptive MV leaflet changes and LV volumes and call for a more sophisticated and comprehensive imaging framework for classifying MR in future interventional studies.
继发性二尖瓣反流（MR）是最常见和治疗不足的 MR 类型，其对预后不良的贡献和纠正适应证仍在讨论中。MR 已根据左心室（LV）和反流容积分为“相称性”或“不成比例性”，而“三级”MR 则确定了反流本身即为病理性并积极导致 LV 功能障碍的情况。超声心动图和解剖病理学研究表明，继发性 MR 促使瓣叶出现细微的适应性改变，积极促进继发性 MR 的动态进展。我们批判性地讨论了从继发性 MR 到三级 MR 的范式转变，并质疑 MV 瓣叶在继发性 MR 中起被动作用的观点。我们还回顾了标准经胸超声心动图在评估和量化适应性 MV 瓣叶变化和 LV 容积中的作用，并呼吁在未来的介入研究中采用更复杂和全面的成像框架来对 MR 进行分类。
