心房功能性二尖瓣反流的研究进展

Research progress on atrial functional mitral regurgitation

心房功能性二尖瓣反流(atrial functional mitral regurgitation,AFMR)是指心房颤动(atrial fibrillation,AF)患者出现的左心房(left atrium,LA)扩大、左心室不扩大或仅轻度扩大、左心室射血分数保留的二尖瓣反流,二尖瓣本身无明显病变的疾病状态。目前针对AFMR的病因、病理生理和机制尚不完全清楚。现有研究发现,AFMR的病因主要包括AF、LA及二尖瓣环扩大,瓣环形状破坏,瓣叶重塑不能代偿瓣环扩张,以及二尖瓣后叶因房室牵拉而导致的损伤等。AFMR与患者的死亡率和心力衰竭再住院等风险增加相关,因此AFMR是心力衰竭合并AF患者的一个重要治疗目标。但目前AFMR的最佳治疗尚存在争议,因此本文将对AFMR的定义、病因、病理生理学机制、治疗及预后相关文献进行综述。

Atrial functional mitral regurgitation(AFMR)is mitral regurgitation in patients with atrial fibrillation(AF),whose left atrium(LA)is enlarged,the left ventricle is not enlarged or only slightly enlarged,the left ventricular ejection fraction is preserved,and the mitral valve itself has no apparent lesion.At present,the etiology,pathophysiology and mechanism of this disease have not been completely clear yet.Existing studies have found that the causes of AFMR mainly include AF,enlargement of LA and mitral annulus,destruction of mitral annular shape,inability of mitral valve remodeling to compensate for mitral annular expansion,and hamstringing of the posterior mitral leaflet by atriogenic tethering.AFMR is demonstrated to be associated with an increased risk of mortality and readmission due to heart failure.Therefore,it serves as a primary therapeutic target for patients with heart failure and AF.However,the optimal treatment of AFMR still remains controversial.Therefore,this article will mainly expound the current definition,etiology,pathophysiological mechanism,treatment,and prognosis of AFMR.