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Subtypes of Atrial Functional Mitral Regurgitation Imaging Insights Into Their Mechanisms and Therapeutic Implications
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2020-03-01 , DOI: 10.1016/j.jcmg.2019.01.040
Nobuyuki Kagiyama , Sergio Mondillo , Kiyoshi Yoshida , Giulia Elena Mandoli , Matteo Cameli

Functional mitral regurgitation (MR) in patients with atrial fibrillation (AF) without left ventricular dysfunction, namely, atrial functional MR, has been increasingly recognized. Whether mitral annular dilatation causes MR in patients without left ventricular dysfunction has remained controversial; however, recent studies using novel imaging technologies, including 3-dimensional echocardiography, have shown that significant functional MR can sometimes occur in AF patients with significant dilatation of mitral annulus and left atrium. Additional contributors such as atriogenic leaflet tethering, annulus area to leaflet area imbalance resulting from insufficient leaflet remodeling and reduced annular contractility, increased valve stress by flattened saddle shape of the annulus, and left atrial dysfunction may be important triggers of atrial functional MR in the presence of dilated mitral annulus and left atrium. The prevalence of atrial functional MR is reported to be between 3% and 15% in AF patients and those with atrial functional MR are associated with worse clinical outcomes. Because there are few published data regarding therapeutic strategies of atrial functional MR, understanding the principles of therapeutic options and their target mechanisms is important with regards to clinical practice until sufficient evidence is established. In this review, the known mechanisms, clinical implications and, when possible, potential therapeutic options of atrial functional MR are discussed.

中文翻译:

心房功能性二尖瓣反流的亚型
将洞察力成像到其机制和治疗意义中


没有左心功能不全的房颤(AF)患者的功能性二尖瓣反流(MR),即房性功能性MR,已得到越来越多的认识。对于没有左心功能不全的患者,二尖瓣环扩张是否会引起MR仍存在争议。但是,最近使用新颖的成像技术(包括3维超声心动图)的研究表明,在二尖瓣环和左心房明显扩张的AF患者中,有时会发生明显的功能性MR。其他因素,如心房小叶栓系,由于小叶重构不足和环形收缩而导致瓣环面积与小叶面积失衡,由于瓣环的鞍形变平而增加了瓣膜应力,在二尖瓣环扩张和左心房扩张的情况下,左心房功能障碍可能是导致心房功能性MR的重要诱因。据报道,房颤患者的房功能性MR患病率在3%至15%之间,而具有房功能性MR的患儿与较差的临床预后相关。由于有关房性MR的治疗策略的公开数据很少,因此在建立足够的证据之前,了解治疗选择的原则及其靶标机制对于临床实践很重要。在这篇综述中,讨论了房性功能性MR的已知机制,临床意义以及可能的治疗选择。据报道,房颤患者的房功能性MR患病率在3%至15%之间,而具有房功能性MR的患儿与较差的临床预后相关。由于有关房性MR的治疗策略的公开数据很少,因此在建立足够的证据之前,了解治疗选择的原则及其靶标机制对于临床实践很重要。在这篇综述中,讨论了房性功能性MR的已知机制,临床意义以及可能的治疗选择。据报道,房颤患者的房功能性MR患病率在3%至15%之间,而具有房功能性MR的患儿与较差的临床预后相关。由于有关房性MR的治疗策略的公开数据很少,因此在建立足够的证据之前,了解治疗选择的原则及其靶标机制对于临床实践很重要。在这篇综述中,讨论了房性功能性MR的已知机制,临床意义以及可能的治疗选择。在建立足够的证据之前,了解治疗选择的原则及其靶标机制对于临床实践很重要。在这篇综述中,讨论了房性功能性MR的已知机制,临床意义以及可能的治疗选择。在建立足够的证据之前,了解治疗选择的原则及其靶标机制对于临床实践很重要。在这篇综述中,讨论了房性功能性MR的已知机制,临床意义以及可能的治疗选择。
更新日期:2020-03-03
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