Houston Methodist Hospital, Houston, Texas, USA.
Massachusetts General Hospital, Boston, Massachusetts, USA.
JACC Cardiovasc Imaging. 2022 Nov;15(11):1870-1882. doi: 10.1016/j.jcmg.2022.08.016.
Functional or secondary mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality. Mechanistically, secondary MR is attributable to an imbalance between mitral leaflet tethering and closure forces, leading to poor coaptation. The pathophysiology of functional MR is most often the result of abnormalities in left ventricular function and remodeling, seen in ischemic or nonischemic conditions. Less commonly and more recently recognized is the scenario in which left ventricular geometry and function are preserved, the culprit being mitral annular enlargement associated with left atrial dilatation, termed atrial functional mitral regurgitation (AFMR). This most commonly occurs in the setting of chronic atrial fibrillation or heart failure with preserved ejection fraction. There is variability in the published reports and in current investigations as to the definition of AFMR. This paper reviews the pathophysiology of AFMR and focus on the need for a collective definition of AFMR to facilitate consistency in reported data and enhance much-needed research into outcomes and treatment strategies in AFMR.
功能性或继发性二尖瓣反流（MR）与心血管发病率和死亡率增加相关。从机制上讲，继发性 MR 归因于二尖瓣叶牵拉力和闭合力之间的失衡，导致对合不良。功能性 MR 的病理生理学通常是左心室功能和重构异常的结果，见于缺血性或非缺血性条件下。不太常见但最近才认识到的情况是，左心室几何形状和功能保持不变，罪魁祸首是与左心房扩张相关的二尖瓣环扩大，称为心房性功能性二尖瓣反流（AFMR）。这种情况最常发生在慢性心房颤动或射血分数保留的心力衰竭中。关于 AFMR 的定义，在已发表的报告和当前的研究中有很大的差异。本文回顾了 AFMR 的病理生理学，并重点讨论了对 AFMR 进行统一定义的必要性，以促进报告数据的一致性，并加强对 AFMR 的结局和治疗策略的急需研究。
