Eclipsed mitral regurgitation: an unusual cause of acute heart failure
Eclipsed mitral regurgitation: an unusual cause of acute heart failure
复制标题
二尖瓣关闭不全：急性心力衰竭的罕见原因
DOI：
10.1093/ehjci/jew192
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
G. Jondeau
中科院分区：
文献类型：
--
作者：
O. Milleron;C. Bouleti;S. Mazouz;E. Brochet;François Rouzet;P. Nataf;W. Ghodbane;D. Messika‐Zeitoun;M. Dilly;S. Cattan;A. Vahanian;Bernard Iung;G. Jondeau
目标
迄今为止，三个不同团队在文献中总共报道了五名重叠二尖瓣反流（MR）患者。本文的目的是详细介绍出现重叠 MR 的患者的临床和超声心动图特征以及结果。
方法和结果
我们将重叠 MR 定义为，在静息状态下，从 1 分钟到下一次二尖瓣叶运动急性受限，阻止接合并导致左心室舒张末期内径正常、左心室射血分数 >45% 和基线 MR ≤2 的患者出现大量 MR。 30分钟内自然消退，不存在急性高血压、新发心律失常或心肌缺血等明显触发因素。报告了 6 名重叠 MR 患者的临床数据、心电图、超声心动图数据、手术报告和随访情况：所有患者都是绝经后女性，中位年龄为 74 [57-80] 岁，患有高血压 (4/6)、慢性肾病 (5/6) 或慢性贫血 (4/6)。六分之五的患者出现急性肺水肿，需要住院治疗，并因心力衰竭复发而接受二尖瓣置换术。两名患者在术后第一天死亡，而另外三名患者分别在随访 56、18 和 10 个月时没有出现任何症状。
结论
Eclipsed MR 是一种临床和超声心动图综合征，可导致 EF 保留的心力衰竭。目前诊断不足，在没有明显触发因素的复发性急性肺水肿的情况下，尤其是随着时间的推移对 MR 严重程度评估不一致的患者，应引起该检查。
Aims
So far, a total of five patients with eclipsed mitral regurgitation (MR) have been reported in the literature by three different teams. The aim of this article was to detail clinical and echocardiographic characteristics, and outcome of patients presenting eclipsed MR.
Methods and results
We defined eclipsed MR as spontaneous appearance, at rest, from 1 min to the next of an acute restriction in the motion of mitral leaflets preventing coaptation and leading to massive MR in patients with normal left ventricular end-diastolic diameter, left ventricular ejection fraction >45%, and baseline MR ≤2. Spontaneous regression occurred within 30 min, and no obvious trigger such as acute hypertension, new-onset arrhythmia, or myocardial ischaemia is present. Clinical data, ECG, echocardiographic data, surgery report, and follow-up status of six patients with eclipsed MR are reported: all were post-menopausal women with median age of 74 [57-80] years presenting hypertension (4/6), chronic kidney disease (5/6), or chronic anaemia (4/6). Five out of six patients experienced acute pulmonary oedema requiring hospitalization and underwent mitral valve replacement because of heart failure recurrence. Two patients died in the first days after surgery while the three others are free of symptoms at, respectively, 56, 18, and 10 months follow-up.
Conclusion
Eclipsed MR is a clinical and echocardiographic syndrome responsible for heart failure with preserved EF. It is presently underdiagnosed and should be evoked in cases of recurrent acute pulmonary oedema without obvious trigger, in particular in patients presenting discordant evaluation of MR severity over time.
影响因子：
37.8
作者：
Senni, M;Tribouilloy, CM;Redfield, MM
通讯作者：
Redfield, MM