Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia-National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands.
Glob Heart. 2023 Mar 17;18(1):15. doi: 10.5334/gh.1192. eCollection 2023.
Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established.
Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR.
The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation.
The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3).
Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.
二尖瓣反流（MR）使左、右心室承受容量或压力超负荷，导致一系列代偿适应，最终导致心室功能障碍。众所周知，在风湿性心脏病（RHD）中，炎症过程不仅发生在瓣膜，还涉及心肌和心包层。然而，风湿性 MR 中的炎症过程除了血流动力学变化外是否与心室功能有关尚不清楚。
评估风湿病因是否与慢性 MR 患者的心室功能障碍有关。
研究人群包括在研究期间在印度尼西亚国家心血管中心 Harapan Kita 进行超声心动图检查的年龄在 18 岁或以上的患者，这些患者患有风湿病因和退行性过程引起的孤立性原发性 MR，且至少为中度反流。
本研究纳入了 1130 例有明显退行性 MR 的患者和 276 例风湿性 MR 的患者。风湿性 MR 患者较年轻，心房颤动和肺动脉高压的患病率较高，左心室（LV）射血分数和三尖瓣环平面收缩期位移（TAPSE）值较差，左心房（LA）内径较大。与退行性二尖瓣反流（MR）患者相比。性别、年龄、LV 收缩末期直径、风湿病因和 TAPSE 与 LV 射血分数受损程度独立相关。而低 LV 射血分数、LV 收缩末期直径和三尖瓣峰值速度（TR）峰值速度>3.4 m/s 与右心室（RV）收缩功能降低独立相关（表 3）。
风湿病因与左心室功能障碍程度增加独立相关；然而，在有明显慢性 MR 的患者中，风湿病因与右心室收缩功能降低无关。
