Aims 

Mitral regurgitation is frequent in the general population and among suspected heart failure patients; however, to what extent it contributes to dyspnoea is unclear. We hypothesized mitral regurgitation to have a role in determining dyspnoea in unselected ambulatory patients.

Methods 

Consecutive outpatients referred for echocardiography were retrospectively screened and included. We excluded patients with mitral stenosis or prosthesis, congenital heart disease, cardiac surgery (previous 6 months) and atrial fibrillation. Patients were classified into four dyspnoea grades based on how they perceived their disability. We assessed mitral regurgitation severity through the effective regurgitant orifice area (ERO).

Results 

One hundred and fifty-four patients (58% men; age 67 ± 14 years; mean ejection fraction 54 ± 12%) formed the study population; 76 (49%) classified asymptomatic (grade I), 63 (41%) dyspnoea grade II and 15 (10%) grade III; none was in grade IV. Mitral regurgitation was present in 102 patients (66%): primary in 14 (14%) and secondary in 88 (86%); among grades I, II and III patients, mitral regurgitation was present in 35 (46%; ERO 0.05 ± 0.10 cm²), 52 (82%; ERO 0.10 ± 0.13 cm²) and 15 (100%; ERO 0.20 ± 0.11 cm²) patients, respectively (P < 0.0001). After adjusting for clinical (age, hypertension, ischemic heart disease, chronic kidney injury, chronic pulmonary disease) and echocardiographic confounders (ejection fraction, E/e‘), ERO remained associated with symptoms presence (grade I versus II - III; P = 0.01 and P = 0.03, respectively).

Conclusion 

Among unselected heterogeneous ambulatory patients, mitral ERO was associated with the presence of dyspnoea and could therefore help in identifying symptomatic patients and in clinical characterization of patients with perceived dyspnoea.

中文翻译：

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二尖瓣反流和呼吸困难：二尖瓣有效反流孔口在未选定患者中的作用正在扩大。

目的 

在普通人群和可疑的心力衰竭患者中，二尖瓣关闭不全很常见。但是，尚不清楚它在多大程度上导致呼吸困难。我们假设二尖瓣关闭不全在确定非选定门诊患者的呼吸困难中具有作用。

方法 

连续筛查转诊接受超声心动图检查的门诊患者并包括在内。我们排除了二尖瓣狭窄或假体，先天性心脏病，心脏手术（前6个月）和心房颤动的患者。根据患者对残疾的感觉，将其分为四个呼吸困难等级。我们通过有效的反流口面积（ERO）评估了二尖瓣反流的严重程度。

结果 

一百五十四名患者（58％的男性；年龄67±14岁；平均射血分数54±12％）构成了研究人群；分类为无症状（I级）的有76（49％），II级呼吸困难有63（41％）和III级为15（10％）。没有一个是四年级的。二尖瓣反流存在于102例患者中（66％）：原发14例（14％），继发88例（86％）；在I，II和III级患者中，二尖瓣反流分别为35（46％; ERO 0.05±0.10 cm ²），52（82％; ERO 0.10±0.13 cm ²）和15（100％; ERO 0.20±0.11 cm ²）分别为患者（P<0.0001）。在调整了临床（年龄，高血压，缺血性心脏病，慢性肾脏损伤，慢性肺病）和超声心动图混杂因素（射血分数，E / e'）后，ERO仍与症状的存在相关（I级对II-III级；P = 0.01和P = 0.03）。

结论 

在未选择的异类卧床患者中，二尖瓣ERO与呼吸困难的存在有关，因此可能有助于识别有症状的患者和感知到的呼吸困难的患者的临床特征。