PDF(Pubmed)
Abstract：
UNASSIGNED: The characteristics and treatment strategies of atrial functional mitral regurgitation (AFMR) are poorly understood.
UNASSIGNED: To investigate the prevalence, clinical characteristics, and outcomes of mitral valve (MV) surgery in AFMR.
UNASSIGNED: This retrospective cohort study, called the Real-World Observational Study for Investigating the Prevalence and Therapeutic Options for Atrial Functional Mitral Regurgitation (REVEAL-AFMR), was conducted across 26 Japanese centers (17 university hospitals, 1 national center, 3 public hospitals, and 5 private hospitals). All transthoracic echocardiography procedures performed from January 1 to December 31, 2019, were reviewed to enroll adult patients (aged ≥20 years) with moderate or severe AFMR, defined by preserved left ventricular function, a dilated left atrium, and an absence of degenerative valvular changes. Data were analyzed from May 8, 2023, to May 16, 2024.
UNASSIGNED: Mitral valve surgery, with or without tricuspid valve intervention.
UNASSIGNED: The primary composite outcome included heart failure hospitalization and all-cause mortality.
UNASSIGNED: In 177 235 patients who underwent echocardiography, 8867 had moderate or severe MR. Within this group, 1007 (11.4%) were diagnosed with AFMR (mean [SD] age, 77.8 [9.5] years; 55.7% female), of whom 807 (80.1%) had atrial fibrillation. Of these patients, 113 underwent MV surgery, with 92 (81.4%) receiving concurrent tricuspid valve surgery. Patients who underwent surgery were younger but had more severe MR (57.5% [n = 65] vs 9.4% [n = 84]; P < .001), a larger mean (SD) left atrial volume index (152.5 [97.8] mL/m2 vs 87.7 [53.1] mL/m2; P < .001), and a higher prevalence of heart failure (according to the New York Heart Association class III [marked limitation of physical activity] or class IV [symptoms of heart failure at rest], 26.5% [n = 30] vs 9.3% [n = 83]; P < .001) than those who remained under medical therapy. During a median follow-up of 1050 days (IQR, 741-1188 days), 286 patients (28.4%) experienced the primary outcome. Despite a more severe disease status, only the surgical group showed a decrease in natriuretic peptide levels at follow-up and had a significantly lower rate of the primary outcome (3-year event rates were 18.3% vs 33.3%; log-rank, P = .03). Statistical adjustments did not alter these findings.
UNASSIGNED: The findings of this cohort study suggest that in patients with AFMR, who were typically older and predominantly had atrial fibrillation, MV surgery was associated with lower rates of adverse clinical outcomes. Future studies are warranted to investigate a possible causal relationship to better regulate cardiovascular medicine.
UNASSIGNED: To investigate the prevalence, clinical characteristics, and outcomes of mitral valve (MV) surgery in AFMR.
UNASSIGNED: This retrospective cohort study, called the Real-World Observational Study for Investigating the Prevalence and Therapeutic Options for Atrial Functional Mitral Regurgitation (REVEAL-AFMR), was conducted across 26 Japanese centers (17 university hospitals, 1 national center, 3 public hospitals, and 5 private hospitals). All transthoracic echocardiography procedures performed from January 1 to December 31, 2019, were reviewed to enroll adult patients (aged ≥20 years) with moderate or severe AFMR, defined by preserved left ventricular function, a dilated left atrium, and an absence of degenerative valvular changes. Data were analyzed from May 8, 2023, to May 16, 2024.
UNASSIGNED: Mitral valve surgery, with or without tricuspid valve intervention.
UNASSIGNED: The primary composite outcome included heart failure hospitalization and all-cause mortality.
UNASSIGNED: In 177 235 patients who underwent echocardiography, 8867 had moderate or severe MR. Within this group, 1007 (11.4%) were diagnosed with AFMR (mean [SD] age, 77.8 [9.5] years; 55.7% female), of whom 807 (80.1%) had atrial fibrillation. Of these patients, 113 underwent MV surgery, with 92 (81.4%) receiving concurrent tricuspid valve surgery. Patients who underwent surgery were younger but had more severe MR (57.5% [n = 65] vs 9.4% [n = 84]; P < .001), a larger mean (SD) left atrial volume index (152.5 [97.8] mL/m2 vs 87.7 [53.1] mL/m2; P < .001), and a higher prevalence of heart failure (according to the New York Heart Association class III [marked limitation of physical activity] or class IV [symptoms of heart failure at rest], 26.5% [n = 30] vs 9.3% [n = 83]; P < .001) than those who remained under medical therapy. During a median follow-up of 1050 days (IQR, 741-1188 days), 286 patients (28.4%) experienced the primary outcome. Despite a more severe disease status, only the surgical group showed a decrease in natriuretic peptide levels at follow-up and had a significantly lower rate of the primary outcome (3-year event rates were 18.3% vs 33.3%; log-rank, P = .03). Statistical adjustments did not alter these findings.
UNASSIGNED: The findings of this cohort study suggest that in patients with AFMR, who were typically older and predominantly had atrial fibrillation, MV surgery was associated with lower rates of adverse clinical outcomes. Future studies are warranted to investigate a possible causal relationship to better regulate cardiovascular medicine.
摘要：
■对心房功能性二尖瓣反流（AFMR）的特征和治疗策略知之甚少。
■为了调查患病率，临床特征,以及AFMR中二尖瓣（MV）手术的结果。
■这项回顾性队列研究，称为真实世界观察性研究，用于研究心房功能性二尖瓣反流的患病率和治疗选择（REVEAL-AFMR），在26个日本中心(17个大学医院，1个国家中心，3家公立医院，和5家私立医院)。2019年1月1日至12月31日进行的所有经胸超声心动图检查，以招募患有中度或重度AFMR的成年患者（年龄≥20岁），由保留的左心室功能定义，扩张的左心房,瓣膜没有退行性改变.数据从2023年5月8日至2024年5月16日进行了分析。
■二尖瓣手术，有或没有三尖瓣介入。
■主要复合结局包括心力衰竭住院和全因死亡率。
■在177235例接受超声心动图检查的患者中，8867有中度或重度MR。在这个群体中,1007例(11.4%)被诊断为AFMR(平均[SD]年龄，77.8[9.5]岁；55.7%女性)，其中807人(80.1%)患有心房颤动。在这些病人中,113例接受了MV手术，92例（81.4%）同时接受三尖瓣手术。接受手术的患者年龄较小，但MR较严重（57.5%[n=65]vs9.4%[n=84]；P<.001），左心房容积指数均值（SD）较大（152.5[97.8]mL/m2vs87.7[53.1]mL/m2；P<.001），心力衰竭的患病率较高（根据纽约心脏协会的III级[明显限制体力活动]或IV级[休息时的心力衰竭症状]，26.5％[n=30]vs9.3％[n=83]；P<.001）比那些仍在接受药物治疗的人。在1050天的中位随访期间(IQR，741-1188天），286例患者（28.4%）经历了主要结果。尽管疾病状态更严重，只有手术组在随访时利钠肽水平下降，主要结局发生率显著降低(3年事件发生率为18.3%vs33.3%;log-rank,P=.03）。统计调整并没有改变这些发现。
■这项队列研究的结果表明，在AFMR患者中，通常年龄较大，主要患有心房颤动，MV手术与较低的不良临床结局相关。未来的研究有必要探讨可能的因果关系，以更好地调节心血管药物。
■为了调查患病率，临床特征,以及AFMR中二尖瓣（MV）手术的结果。
■这项回顾性队列研究，称为真实世界观察性研究，用于研究心房功能性二尖瓣反流的患病率和治疗选择（REVEAL-AFMR），在26个日本中心(17个大学医院，1个国家中心，3家公立医院，和5家私立医院)。2019年1月1日至12月31日进行的所有经胸超声心动图检查，以招募患有中度或重度AFMR的成年患者（年龄≥20岁），由保留的左心室功能定义，扩张的左心房,瓣膜没有退行性改变.数据从2023年5月8日至2024年5月16日进行了分析。
■二尖瓣手术，有或没有三尖瓣介入。
■主要复合结局包括心力衰竭住院和全因死亡率。
■在177235例接受超声心动图检查的患者中，8867有中度或重度MR。在这个群体中,1007例(11.4%)被诊断为AFMR(平均[SD]年龄，77.8[9.5]岁；55.7%女性)，其中807人(80.1%)患有心房颤动。在这些病人中,113例接受了MV手术，92例（81.4%）同时接受三尖瓣手术。接受手术的患者年龄较小，但MR较严重（57.5%[n=65]vs9.4%[n=84]；P<.001），左心房容积指数均值（SD）较大（152.5[97.8]mL/m2vs87.7[53.1]mL/m2；P<.001），心力衰竭的患病率较高（根据纽约心脏协会的III级[明显限制体力活动]或IV级[休息时的心力衰竭症状]，26.5％[n=30]vs9.3％[n=83]；P<.001）比那些仍在接受药物治疗的人。在1050天的中位随访期间(IQR，741-1188天），286例患者（28.4%）经历了主要结果。尽管疾病状态更严重，只有手术组在随访时利钠肽水平下降，主要结局发生率显著降低(3年事件发生率为18.3%vs33.3%;log-rank,P=.03）。统计调整并没有改变这些发现。
■这项队列研究的结果表明，在AFMR患者中，通常年龄较大，主要患有心房颤动，MV手术与较低的不良临床结局相关。未来的研究有必要探讨可能的因果关系，以更好地调节心血管药物。
