De Schutter Stephanie, Van Damme Eline, Van Hout Galathea, Pype Lobke L, Gevaert Andreas B, Van Craenenbroeck Emeline M, Claeys Marc J, Van De Heyning Caroline M
Research group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Research group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium.
Am J Cardiol. 2025 Apr 1;240:57-63. doi: 10.1016/j.amjcard.2024.12.033. Epub 2025 Jan 10.
Atrial functional mitral regurgitation (AFMR) is a distinct form of mitral regurgitation in patients with atrial fibrillation and heart failure with preserved ejection fraction. Its pathophysiology remains elusive, and data on exercise-related AFMR are scarce. We sought to investigate the impact of acute exercise on AFMR severity and to identify its determinants. In total, 47 patients with heart failure with preserved ejection fraction (n = 39) and/or atrial fibrillation (n = 22) were enrolled. We assessed AFMR severity, mitral annular dimensions, left atrial size, AFMR severity, and parameters of systolic and diastolic function at rest and during maximal exercise by echocardiography. An increase in AFMR severity of ≥1 grade was observed in 20 patients (43%) during exercise and was associated with impaired progression of peak mitral annulus systolic velocity and increased systolic mitral annular diameter during exercise, whereas the systolic annular diameter decreased in patients without AFMR progression. Furthermore, patients with ≥ moderate AFMR during exercise (n = 19, 40%) had lower peak mitral annulus systolic velocity, greater systolic mitral annular diameters, reduced tricuspid annular plane systolic excursion, and more severe tricuspid regurgitation than patients with ≤ mild MR during exercise. In conclusion, AFMR is a dynamic condition which may worsen during exercise. Deterioration of AFMR during exercise was associated with impaired longitudinal left ventricular contractile reserve and greater mitral annular dimensions. Because impaired left ventricular longitudinal function may influence mitral annular dynamics, this attributes to the hypothesis that AFMR results from mitral annulus area/leaflet area imbalance caused by annular dilation and impaired mitral annular dynamics.
心房功能性二尖瓣反流（AFMR）是心房颤动和射血分数保留的心力衰竭患者中一种独特的二尖瓣反流形式。其病理生理学仍不清楚，关于运动相关AFMR的数据也很稀少。我们试图研究急性运动对AFMR严重程度的影响并确定其决定因素。总共纳入了47例射血分数保留的心力衰竭患者（n = 39）和/或心房颤动患者（n = 22）。我们通过超声心动图评估了静息和最大运动时的AFMR严重程度、二尖瓣环尺寸、左心房大小、AFMR严重程度以及收缩和舒张功能参数。20例患者（43%）在运动期间观察到AFMR严重程度增加≥1级，这与运动期间二尖瓣环峰值收缩速度进展受损和收缩期二尖瓣环直径增加有关，而在无AFMR进展的患者中收缩期环直径减小。此外，运动期间AFMR≥中度的患者（n = 19，40%）比运动期间MR≤轻度的患者二尖瓣环峰值收缩速度更低、收缩期二尖瓣环直径更大、三尖瓣环平面收缩期位移减少且三尖瓣反流更严重。总之，AFMR是一种动态情况，在运动期间可能会恶化。运动期间AFMR的恶化与左心室纵向收缩储备受损和二尖瓣环尺寸增大有关。由于左心室纵向功能受损可能影响二尖瓣环动力学，这支持了AFMR是由环扩张和二尖瓣环动力学受损导致的二尖瓣环面积/瓣叶面积失衡引起的这一假说。
