Heart failure with preserved ejection fraction in atrial functional mitral regurgitation - Insight from the REVEAL-AFMR

被引：1

作者：

Kagami, Kazuki ^{[1
,2
]}

Kagiyama, Nobuyuki ^{[3
]}

Kaneko, Tomohiro ^{[3
]}

Harada, Tomonari ^{[1
]}

Sato, Kimi ^{[4
]}

Amano, Masashi ^{[5
]}

Okada, Taiji ^{[6
]}

Sato, Yukio ^{[7
]}

Ohno, Yohei ^{[8
]}

Morita, Kojiro ^{[9
]}

Machino-Ohtsuka, Tomoko ^{[4
]}

Abe, Yukio ^{[10
]}

Ishii, Hideki ^{[1
]}

Obokata, Masaru ^{[1
]}

机构：

[1] Gunma Univ, Grad Sch Med, Dept Cardiovasc Med, 3-39-22 Showa Machi, Maebashi, Gunma 3718511, Japan

[2] Natl Def Med Coll, Dept Med Engn, 3-2 Namiki Cho, Tokorozawa, Saitama 3598513, Japan

[3] Juntendo Univ, Dept Cardiovasc Biol & Med, Grad Sch Med, 2-1-1 Hongo,Bunkyo ku, Tokyo, Japan

[4] Univ Tsukuba, Inst Med, Dept Gastroenterol, 2-1-1 Amakubo, Ibaraki, 3058576, Japan

[5] Natl Cerebral & Cardiovasc Ctr, Dept Heart Failure & Transplantat, 6-1 Kishibe Shimmachi, Suita, Osaka, Japan

[6] Kobe City Med Ctr Gen Hosp, Dept Cardiovasc Med, 2-1-1 Minatojima Minamimachi,Chuo Ku, Kobe, Japan

[7] St Marianna Univ, Sch Med, Sch Med, Kawasaki, Japan

[8] Tokai Univ, Sch Med, Dept Cardiol, 143 Shimokasuya, Isehara, Kanagawa, Japan

[9] Univ Tokyo, Sch Publ Hlth, Grad Sch Med, Dept Clin Epidemiol & Hlth Econ, 7-3-1 Hongo,Bunkyo Ku, Tokyo, Japan

[10] Osaka City Gen Hosp, Dept Cardiol, 2-13-22 Miyakojima Hondori Miyakojima Ku, Osaka, Japan

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2025年 / 422卷

基金：

日本学术振兴会;

关键词：

Atrial functional mitral regurgitation; Heart failure with preserved ejection fraction; Atrial fibrillation; Rhythm control; Mitral valve surgery; Tricuspid valve surgery; FIBRILLATION; OUTCOMES; REPAIR;

D O I：

10.1016/j.ijcard.2025.132958

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Atrial functional mitral regurgitation (AFMR) and heart failure with a preserved ejection fraction (HFpEF) often coexist. However, the clinical impact of HFpEF in patients with AFMR has not been well characterized. This study aimed to determine clinical outcomes and response to mitral valve (MV) intervention or rhythm control therapy in patients with HFpEF and moderate AFMR (HFpEF-AFMR). Methods: This was a post-hoc analysis of the REVEAL-AFMR, a retrospective observational study involving patients with >= moderate AFMR. After excluding patients with severe MR, the presence of HFpEF was defined by the Universal definition. Results: Of 438 patients with moderate AFMR, 352 met the criteria of HFpEF (prevalence: 80 %). Compared to non-HFpEF-AFMR (n = 86), patients with HFpEF-AFMR were older and had greater symptom burden and a higher prevalence of severe tricuspid regurgitation (19 %). During a median follow-up of 33.2 months, a composite outcome of all-cause mortality or HF hospitalization occurred in 130 patients. Patients with HFpEF-AFMR had a 3.6-fold increased risk of the composite outcome compared to non-HFpEF-AFMR. While MV intervention was not associated with outcomes in HFpEF-AFMR, concomitant tricuspid valve (TV) procedures were associated with a better outcome than isolated MV intervention (HR 0.15, 95 %CI 0.04-0.54, p = 0.009). Catheter or surgical rhythm control showed a favorable outcome in HFpEF-AFMR and atrial fibrillation (HR 0.38, 95 %CI 0.17-0.87, p = 0.008). Conclusion: HFpEF was substantially common in moderate AFMR and was associated with worse clinical outcomes. Simultaneous MV and TV intervention procedures or rhythm control therapy were associated with better clinical outcomes in HFpEF-AFMR.

引用

页数：8