Evidence of Atrial Functional Mitral Regurgitation Due to Atrial Fibrillation Reversal With Arrhythmia Control
Evidence of Atrial Functional Mitral Regurgitation Due to Atrial Fibrillation Reversal With Arrhythmia Control
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DOI：
10.1016/j.jacc.2011.06.032
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发表时间：
2011-09-27
影响因子：
24
通讯作者：
Silvestry, Frank E.
中科院分区：
文献类型：
--
作者：
Gertz, Zachary M.;Raina, Amresh;Silvestry, Frank E.
目的探讨心房颤动（AF）是否会引起二尖瓣返流（MR），以及恢复窦性心律后二尖瓣返流是否会改善。背景MR可根据瓣叶病理（器质性/原发性和功能性/继发性）和瓣叶运动（正常、过度、限制性）进行分类。继发性，正常瓣叶运动MR的存在仍然存在争议。筛选在我们机构接受首次AF消融术的患者（n = 828）。纳入患者在消融时和1年临床随访时进行了超声心动图检查。MR组群（n = 53）具有至少中度MR。参考组群（n = 53）从具有轻度或较少MR的那些患者（n = 660）中随机选择。比较基线超声心动图和临床特征，结果二尖瓣返流患者年龄较大，持续性房颤发生率较高（62%对23%，p <0.0001）。二尖瓣返流患者的左心房较大（容积指数：32 cm（3）/m（2）vs. 26 cm（3）/m（2），p = 0.008），瓣环尺寸较大（3.49 cm vs. 3.23 cm，p = 0.001），但左心室尺寸和射血分数相似。瓣环大小、年龄和持续性房颤与二尖瓣返流独立相关。随访超声心动图显示，持续性窦性心律患者的左房大小和瓣环尺寸缩小更大，显著二尖瓣返流发生率更低（24% vs. 82%，P = 0.005）。结论房颤可导致心房功能性MR如果恢复窦性心律就会好转（J Am科尔心脏病学杂志2011; 58：1474 - 81）（C）美国心脏病学会基金会2011年
Objectives The purpose of this study was to determine whether atrial fibrillation (AF) might cause significant mitral regurgitation (MR), and to see whether this MR improves with restoration of sinus rhythm.Background MR can be classified by leaflet pathology (organic/primary and functional/secondary) and by leaflet motion (normal, excessive, restrictive). The existence of secondary, normal leaflet motion MR remains controversial.Methods We performed a retrospective cohort study. Patients undergoing first AF ablation at our institution (n = 828) were screened. Included patients had echocardiograms at the time of ablation and at 1-year clinical follow-up. The MR cohort (n = 53) had at least moderate MR. A reference cohort (n = 53) was randomly selected from those patients (n = 660) with mild or less MR. Baseline echocardiographic and clinical characteristics were compared, and the effect of restoration of sinus rhythm was assessed by follow-up echocardiograms.Results MR patients were older than controls and more often had persistent AF (62% vs. 23%, p < 0.0001). MR patients had larger left atria (volume index: 32 cm(3)/m(2) vs. 26 cm(3)/m(2), p = 0.008) and annular size (3.49 cm vs. 3.23 cm, p = 0.001), but similar left ventricular size and ejection fraction. Annular size, age and persistent AF were independently associated with MR. On follow-up echocardiogram, patients in continuous sinus rhythm had greater reductions in left atrial size and annular dimension, and lower rates of significant MR (24% vs. 82%, p = 0.005) compared with those in whom sinus rhythm was not restored.Conclusions AF can result in "atrial functional MR" that improves if sinus rhythm is restored. (J Am Coll Cardiol 2011;58: 1474-81) (C) 2011 by the American College of Cardiology Foundation