Chen Qin-Fen, Zhou Xi, Katsouras Christos S, Ni Chao, Zhu Han, Liu Chenyang, Peng Yangdi, Ge Hang-Bin, Hong Chenglv, Lin Wei-Hong, Zhou Xiao-Dong
Medical Care Center, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou 325000, China.
Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou 325000, China.
Eur Heart J Cardiovasc Imaging. 2025 Mar 3;26(3):545-556. doi: 10.1093/ehjci/jeae309.
Limited data exist on the natural history of functional mitral regurgitation (FMR), including atrial (AFMR), ventricular (VFMR), and dual FMR. This study examined the prevalence, characteristics, outcomes, and progression of these FMR subtypes.
Consecutive patients with ≥mild to moderate FMR were included and classified as AFMR, VFMR, or dual FMR. AFMR is characterized by left atrial enlargement, while VFMR involves left ventricular enlargement or reduced left ventricular ejection fraction. Dual FMR combines features of both. Clinical outcome was all-cause mortality and heart failure (HF) hospitalization. Echocardiographic outcome was the progression from mild-moderate/moderate to severe FMR and from AFMR/VFMR to dual FMR. Of 22 814 patients, AFMR, VFMR, and dual FMR were identified in 39%, 14%, and 47%, respectively. Most (84%) had mild-moderate to moderate FMR. Over a median clinical follow-up of 4.7 years, dual FMR has the highest risk of all-cause mortality and HF hospitalization. Compared with AFMR, patients with VFMR have a higher incidence of all-cause mortality (adjusted HR = 1.73, 95%CI 1.54-1.94, P < 0.001) and HF hospitalization (adjusted HR = 1.23, 95%CI 1.15-1.32, P < 0.001). In the serial cohort with 2.4 (1.0-4.9) years echocardiogram follow-up, VFMR was associated with a 1.51-fold and 3.08-fold increase in the risk of progressing to severe FMR and dual FMR than AFMR (both P < 0.001). Sensitivity analyses did not change these findings.
AFMR and VFMR have significant differences in survival and disease progression. Dual FMR is a common and distinct disease process that occurs in the progression of AFMR or VFMR and is associated with a poor prognosis.
关于功能性二尖瓣反流（FMR）的自然史数据有限，包括心房性（AFMR）、心室性（VFMR）和双重性FMR。本研究调查了这些FMR亚型的患病率、特征、结局及进展情况。
纳入连续的≥轻度至中度FMR患者，并分为AFMR、VFMR或双重性FMR。AFMR的特征为左心房扩大，而VFMR涉及左心室扩大或左心室射血分数降低。双重性FMR兼具两者特征。临床结局为全因死亡率和心力衰竭（HF）住院率。超声心动图结局为从轻度/中度/中度进展至重度FMR以及从AFMR/VFMR进展至双重性FMR。在22814例患者中，分别有39%、14%和47%被识别为AFMR、VFMR和双重性FMR。大多数（84%）为轻度至中度FMR。在中位4.7年的临床随访中，双重性FMR的全因死亡率和HF住院风险最高。与AFMR相比，VFMR患者的全因死亡率（校正风险比[HR]=1.73，95%置信区间[CI]1.54 - 1.94，P<0.001）和HF住院率（校正HR = 1.23，95%CI 1.15 - 1.32，P<0.001）更高。在有2.4（1.0 - 4.9）年超声心动图随访的连续队列中，VFMR进展至重度FMR和双重性FMR的风险比AFMR分别增加1.51倍和3.08倍（均P<0.001）。敏感性分析未改变这些结果。
AFMR和VFMR在生存及疾病进展方面存在显著差异。双重性FMR是一种常见且独特的疾病过程，发生于AFMR或VFMR的进展过程中，且预后不良。
