Prognostic comparison of atrial and ventricular functional mitral regurgitation.
Prognostic comparison of atrial and ventricular functional mitral regurgitation.
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DOI：
10.1136/openhrt-2021-001574
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发表时间：
2021-03
期刊：
影响因子：
2.7
通讯作者：
Izumi C
中科院分区：
文献类型：
--
作者：
Okamoto C;Okada A;Nishimura K;Moriuchi K;Amano M;Takahama H;Amaki M;Hasegawa T;Kanzaki H;Fujita T;Kobayashi J;Yasuda S;Izumi C
心房功能性二尖瓣返流（A-FMR）已被认为是功能性二尖瓣返流（MR）的新病因，但其预后和预后预测因子尚未完全阐明。本研究的目的是探讨A-FMR与心室功能性MR（V-FMR）的预后和预后预测因素。研究了378例中重度或重度功能性MR的连续患者。根据左心室（LV）或左心房（LA）的改变沿着临床背景和缺血性心脏病或心肌病的诊断，将功能性MR分为V-FMR（N=288）和A-FMR（N=90）。中位随访时间为4.1（2.0-6.7）年，分别有98例（26%）、81例（21%）和177例（47%）患者发生全因死亡、心血管死亡和心力衰竭（HF）住院，V-FMR组的这些事件发生率以及全因死亡率和HF住院的复合终点始终高于A-FMR组（未校正HR 1.762（95% CI 1.250至2.438），p<0.001;校正HR 1.654（95% CI 1.027至2.664），p=0.038，对于复合终点）。V-FMR和A-FMR的预后预测因子不同，年龄和左心房容积指数是V-FMR和A-FMR的独立预后预测因子，收缩压和B型利钠肽也是V-FMR的独立预后预测因子，估计肾小球滤过率、左心室收缩末期内径和三尖瓣返流也是A-FMR的独立预后预测因子。V-FMR的预后明显差于A-FMR，且V-FMR与A-FMR的预后预测因素不同。我们的研究表明，区分A-FMR和V-FMR的重要性，以及不同的治疗策略可以考虑每种病因。
Atrial functional mitral regurgitation (A-FMR) has been suggested as a new aetiology of functional MR (MR); however, its prognosis and prognostic predictors are not fully elucidated. Aim of this study was to investigate the prognosis and prognostic predictors of A-FMR in comparison with ventricular functional MR (V-FMR). Three hundred and seventy-eight consecutive patients with moderate-to-severe or severe functional MR were studied. Functional MR was classified into V-FMR (N=288) and A-FMR (N=90) depending on the alterations of left ventricle (LV) or left atrium (LA) along with clinical context and diagnosis of ischaemic heart disease or cardiomyopathy. During a median follow-up of 4.1 (2.0–6.7) years, all-cause mortality, cardiovascular mortality and heart failure (HF) hospitalisation occurred in 98 (26%), 81 (21%) and 177 (47%) patients, respectively, and rates of these events and the composite end point of all-cause mortality and HF hospitalisation were consistently higher in V-FMR than A-FMR (unadjusted HR 1.762 (95% CI 1.250 to 2.438), p<0.001; adjusted HR 1.654 (95% CI 1.027 to 2.664), p=0.038, for the composite end point). Further analysis showed different prognostic predictors between V-FMR and A-FMR; while age and LA volume index were independent prognostic predictors of both V-FMR and A-FMR, systolic blood pressure and B-type natriuretic peptide were also those of V-FMR, and estimated glomerular filtration rate, LV end-systolic dimension and tricuspid regurgitation were also those of A-FMR. The prognosis of V-FMR was significantly worse than that of A-FMR, and prognostic predictors were different between V-FMR and A-FMR. Our study suggests the importance of discriminating A-FMR and V-FMR, and that different treatment strategies may be considered for each aetiology.
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影响因子：
158.5
作者：
Obadia, J. -F.;Messika-Zeitoun, D.;Mewton, N.
通讯作者：
Mewton, N.
影响因子：
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作者：
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Hagiwara, Nobuhisa
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3.5
作者：
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