Prevalence, clinical characteristics, and outcome of atrial functional mitral regurgitation in hospitalized heart failure patients with atrial fibrillation
Prevalence, clinical characteristics, and outcome of atrial functional mitral regurgitation in hospitalized heart failure patients with atrial fibrillation
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DOI：
10.1016/j.jjcc.2018.04.002
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发表时间：
2018-09-01
影响因子：
2.5
通讯作者：
Hagiwara, Nobuhisa
中科院分区：
文献类型：
--
作者：
Saito, Chihiro;Minami, Yuichiro;Hagiwara, Nobuhisa
背景资料：由左心室射血分数（EF）降低和栓系引起的功能性二尖瓣返流（MR），称为心室功能性MR（VFMR），与不良结局相关。心房功能性二尖瓣返流（AFMR）是由左心房扩大和瓣环扩张引起的，最近在房颤（AF）患者中也有报道。然而，AFMR在住院心力衰竭（HF）患者中的临床特征尚不清楚。我们调查了住院HF伴AF患者AFMR的患病率、临床特征和预后。方法：我们分析了189例住院HF伴AF患者。比较了4组患者的患病率、临床特征和预后：EF ≥ 50%且无/轻度MR（pEFnoMR）、EF 50%且中/重度MR（AFMR）、EF ≥ 50%且中/重度MR（VFMR）患者。AFMR的患病率为15.9%，在住院的HF患者AF。AFMR患者年龄较大，更可能有一个扩大的左心房，帐篷高度较低，中度/重度三尖瓣返流比VFMR患者。pEFnoMR、rEFnoMR和AFMR患者出院后全因死亡率无差异。与pEFnoMR和rEFnoMR患者相比，AFMR患者的心源性死亡和HF再入院复合发生率更高（对数秩p = 0.046和p = 0.004）。AFMR和VFMR患者之间的复合终点无差异（对数秩p = 0.507）。结论：AFMR存在于一定比例的老年住院HF AF患者中，是一种需要注意的情况，因为在住院HF队列中因HF再次入院。(C)2018年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Functional mitral regurgitation (MR) caused by reduced left ventricular ejection fraction (EF) and tethering, termed ventricular functional MR (VFMR), is associated with worse outcomes. Atrial functional MR (AFMR) caused by left atrial enlargement and annular dilatation was also recently described in patients with atrial fibrillation (AF). However, the clinical profiles of AFMR in hospitalized heart failure (HF) patients are unclear. We investigated the prevalence, clinical characteristics, and prognosis of AFMR in hospitalized HF patients with AF.Methods: We analyzed 189 hospitalized HF patients with AF. The prevalence, clinical characteristics, and prognosis were compared between 4 groups: patients with EF >= 50% and no/mild MR (pEFnoMR), patients with EF 50% and moderate/severe MR (AFMR), and patients with EF >= 50% and moderate/severe MR (VFMR).Results: The prevalence of AFMR was 15.9% in hospitalized HF patients with AF. AFMR patients were older and more likely to have an enlarged left atrium, lower tenting height, and moderate/severe tricuspid regurgitation than VFMR patients. There were no differences in all-cause death after discharge among pEFnoMR, rEFnoMR, and AFMR patients. AFMR patients were associated with a higher rate of a composite of cardiac death and readmission for HF compared with pEFnoMR and rEFnoMR patients (log-rank p = 0.046 and p = 0.004). There were no differences in composite endpoints between AFMR and VFMR patients (log-rank p = 0.507).Conclusions: AFMR was present in a proportion of elderly hospitalized HF patients with AF, and was a condition requiring attention because of readmission for HF in a hospitalized HF cohort. (C) 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.