Kagami Kazuki, Kagiyama Nobuyuki, Kaneko Tomohiro, Harada Tomonari, Sato Kimi, Amano Masashi, Okada Taiji, Sato Yukio, Ohno Yohei, Morita Kojiro, Machino-Ohtsuka Tomoko, Abe Yukio, Ishii Hideki, Obokata Masaru
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, Japan; Division of Cardiovascular Medicine, National Defense Medical College, 3-2 Namiki-cho, Tokorozawa, Saitama, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, Japan.
Int J Cardiol. 2025 Mar 1;422:132958. doi: 10.1016/j.ijcard.2025.132958. Epub 2025 Jan 3.
Atrial functional mitral regurgitation (AFMR) and heart failure with a preserved ejection fraction (HFpEF) often coexist. However, the clinical impact of HFpEF in patients with AFMR has not been well characterized. This study aimed to determine clinical outcomes and response to mitral valve (MV) intervention or rhythm control therapy in patients with HFpEF and moderate AFMR (HFpEF-AFMR).
This was a post-hoc analysis of the REVEAL-AFMR, a retrospective observational study involving patients with ≥ moderate AFMR. After excluding patients with severe MR, the presence of HFpEF was defined by the Universal definition.
Of 438 patients with moderate AFMR, 352 met the criteria of HFpEF (prevalence: 80 %). Compared to non-HFpEF-AFMR (n = 86), patients with HFpEF-AFMR were older and had greater symptom burden and a higher prevalence of severe tricuspid regurgitation (19 %). During a median follow-up of 33.2 months, a composite outcome of all-cause mortality or HF hospitalization occurred in 130 patients. Patients with HFpEF-AFMR had a 3.6-fold increased risk of the composite outcome compared to non-HFpEF-AFMR. While MV intervention was not associated with outcomes in HFpEF-AFMR, concomitant tricuspid valve (TV) procedures were associated with a better outcome than isolated MV intervention (HR 0.15, 95 %CI 0.04-0.54, p = 0.009). Catheter or surgical rhythm control showed a favorable outcome in HFpEF-AFMR and atrial fibrillation (HR 0.38, 95 %CI 0.17-0.87, p = 0.008).
HFpEF was substantially common in moderate AFMR and was associated with worse clinical outcomes. Simultaneous MV and TV intervention procedures or rhythm control therapy were associated with better clinical outcomes in HFpEF-AFMR.
心房功能性二尖瓣反流（AFMR）与射血分数保留的心力衰竭（HFpEF）常并存。然而，HFpEF对AFMR患者的临床影响尚未得到充分描述。本研究旨在确定HFpEF合并中度AFMR（HFpEF-AFMR）患者的临床结局以及对二尖瓣（MV）干预或节律控制治疗的反应。
这是一项对REVEAL-AFMR研究的事后分析，REVEAL-AFMR是一项涉及≥中度AFMR患者的回顾性观察性研究。在排除重度二尖瓣反流患者后，根据通用定义确定HFpEF的存在。
在438例中度AFMR患者中，352例符合HFpEF标准（患病率：80%）。与非HFpEF-AFMR患者（n = 86）相比，HFpEF-AFMR患者年龄更大，症状负担更重，重度三尖瓣反流患病率更高（19%）。在中位随访33.2个月期间，130例患者发生了全因死亡或心力衰竭住院的复合结局。与非HFpEF-AFMR患者相比，HFpEF-AFMR患者发生复合结局的风险增加了3.6倍。虽然MV干预与HFpEF-AFMR患者的结局无关，但同期三尖瓣（TV）手术与单独MV干预相比，结局更好（风险比0.15，95%置信区间0.04-0.54，p = 0.009）。导管或手术节律控制在HFpEF-AFMR合并心房颤动患者中显示出良好结局（风险比0.38，95%置信区间0.17-0.87，p = 0.008）。
HFpEF在中度AFMR中相当常见，且与更差的临床结局相关。在HFpEF-AFMR患者中，同时进行MV和TV干预手术或节律控制治疗与更好的临床结局相关。
