BACKGROUND Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS In patients with AF and absent LA contraction, the normal predominantly "atriogenic" annular dynamics become "ventriculogenic." Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. "Atrial" functional MR may not be purely an atrial disorder.

中文翻译：

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心房功能性二尖瓣反流的二尖瓣环和左心室动力学：三维和斑点跟踪超声心动图研究。

背景技术患有房颤（AF）和左心房（LA）扩大的患者可能会发生功能正常的小叶运动性二尖瓣反流（MR），而无左心室（LV）重塑。二尖瓣环动力学和左室力学对于保持正常的二尖瓣功能很重要。这项研究的目的是评估房颤和功能性MR患者的环形和左心室动力学。方法回顾性分析21例中度或以上MR房颤患者（AFMR +组），46例无中度或轻度MR房颤患者（AFMR-组）和19例正常患者。使用三维超声心动图定量评估二尖瓣环动力学。使用二维散斑跟踪超声心动图测量收缩期LV总纵向应变（GLS），总周向应变和LA应变。结果正常环显示收缩前收缩后收缩和鞍形增加（所有P <.01）。两组房颤患者的收缩前环形动力学均被取消（相对于正常，P> .05）。相反，AFMR-患者保留了心脏周期中的收缩期和总环状动力学（P> .10，相对于正常），而AFMR +患者则受损（P <.05，相对于正常和AFMR-）。与AFMR-患者相比，尽管LA和LV的体积相当，但LVMR的LV GLS（P <.0001）和LA的应变（P = .02），而不是LV的整体圆周应变（P = .97）受损。MR严重程度与收缩期环形收缩（r = 0.64，P <.0001），鞍座加深（r = 0.53，P = .003）和LV GLS（r = 0.46，P <.0001）相关。多变量分析表明，收缩收缩受损（比值比为2.18； P = .001）和鞍座加深（比值比为2.68； P = .04）与MR独立相关。从模型中排除环形动力学，负负LV GLS较少，但LA应变不负，因此与MR相关（比值比为1.93； P <.0001）。结论在患有AF且没有LA收缩的患者中，正常的以“房颤”为主的环形动力学成为“脑室颤动”。孤立的LA扩张不足以引起重要的MR，而不会在收缩期同时存在异常的LV力学和环形动力学。“心房”功能性MR可能并非单纯的心房疾病。较少的负LV GLS阴性但与LA无关，与MR相关（比值1.93； P <.0001）。结论在患有AF且没有LA收缩的患者中，正常的以“房颤”为主的环形动力学成为“脑室颤动”。孤立的LA扩张不足以引起重要的MR，而不会在收缩期同时存在异常的LV力学和环形动力学。“心房”功能性MR可能并非单纯的心房疾病。较少的负LV GLS阴性但与LA无关，与MR相关（比值1.93； P <.0001）。结论在患有AF且没有LA收缩的患者中，正常的以“房颤”为主的环形动力学成为“脑室颤动”。孤立的LA扩张不足以引起重要的MR，而不会在收缩期同时存在异常的LV力学和环形动力学。“心房”功能性MR可能并非单纯的心房疾病。孤立的LA扩张不足以引起重要的MR，而不会在收缩期同时存在异常的LV力学和环形动力学。“心房”功能性MR可能并非单纯的心房疾病。孤立的LA扩张不足以引起重要的MR，而不会在收缩期同时存在异常的LV力学和环形动力学。“心房”功能性MR可能并非单纯的心房疾病。