Di Muro Francesca Maria, Spadafora Luigi, Buonpane Angela, Leuzzi Francesco, Nardi Giulia, Bossone Eduardo, Biondi Zoccai Giuseppe, Attisano Tiziana, Meucci Francesco, Di Mario Carlo, Vecchione Carmine, Galasso Gennaro
Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città di Ippocrate, 84131 Salerno, Italy.
Department of Structural Interventional Cardiology, Careggi University Hospital, 50134 Florence, Italy.
J Pers Med. 2025 Aug 13;15(8):372. doi: 10.3390/jpm15080372.
Functional mitral regurgitation (FMR) is a common condition with significant prognostic implications, primarily driven by left atrial or ventricular remodeling secondary to ischemic or non-ischemic cardiomyopathies. While guideline-directed medical therapy (GDMT) remains the cornerstone of management, reducing mitral regurgitation severity in up to 40-45% of cases, additional interventions are often necessary. In patients where atrial fibrillation (AF) or ventricular dyssynchrony due to abnormal electrical conduction contributes to disease progression, guideline-directed AF management or cardiac resynchronization therapy plays a pivotal role. For those with persistent moderate to severe MR and unresolved symptoms despite optimal GDMT, percutaneous intervention may be warranted, provided specific clinical and echocardiographic criteria are met. This review highlights a precision-medicine approach to patient selection for transcatheter treatment of functional mitral regurgitation (FMR), emphasizing the integration of clinical characteristics with advanced multimodal imaging, including echocardiography, cardiac magnetic resonance, and computed tomography. In anatomically or clinically complex cases, complementary use of these imaging modalities is essential to ensure accurate phenotyping and procedural planning. Once a suitable candidate for percutaneous intervention has been identified, we provide a detailed overview of current transcatheter strategies, with a focus on device selection tailored to anatomical and pathophysiological features. Finally, we discuss emerging technologies and evolving therapeutic paradigms that are shaping the future of individualized FMR management.
功能性二尖瓣反流（FMR）是一种常见病症，具有重要的预后意义，主要由缺血性或非缺血性心肌病继发的左心房或心室重构所致。虽然指南指导的药物治疗（GDMT）仍然是治疗的基石，可使高达40%-45%的病例二尖瓣反流严重程度降低，但通常还需要额外的干预措施。在因异常电传导导致心房颤动（AF）或心室不同步从而促使疾病进展的患者中，指南指导的房颤管理或心脏再同步治疗起着关键作用。对于那些尽管接受了最佳GDMT但仍有持续性中重度二尖瓣反流且症状未缓解的患者，若符合特定的临床和超声心动图标准，则可能需要进行经皮介入治疗。本综述强调了一种精准医学方法，用于功能性二尖瓣反流（FMR）经导管治疗的患者选择，强调将临床特征与先进的多模态成像（包括超声心动图、心脏磁共振和计算机断层扫描）相结合。在解剖学或临床复杂的病例中，互补使用这些成像方式对于确保准确的表型分析和手术规划至关重要。一旦确定了适合经皮介入治疗的候选者，我们将详细概述当前的经导管策略，重点是根据解剖和病理生理特征量身定制的器械选择。最后，我们讨论正在塑造个性化FMR管理未来的新兴技术和不断发展的治疗模式。
