Atrial Functional Mitral Regurgitation and Exercise-Induced Changes in Heart Failure With Preserved Ejection Fraction.

IF 15.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2025-09-05 DOI:10.1016/j.jcmg.2025.07.016

Sebastiaan Dhont, Wouter L'Hoyes, Sara Moura Ferreira, Pieter Martens, Jan Stassen, Guido Claessen, Sarah Stroobants, Siddharth Jogani, Ruta Jasaityte, Lieven Herbots, Jan Verwerft, Philippe B Bertrand

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引用次数: 0

Abstract

Background: Atrial functional mitral regurgitation (AFMR) is prevalent among patients with heart failure with preserved ejection fraction (HFpEF) and associated with adverse outcome, yet this bidirectional association remains underexplored.

Objectives: The purpose of this study was to elucidate the pathophysiological and prognostic significance of AFMR in HFpEF, both at rest and during exercise.

Methods: In this multicenter cohort study, consecutive patients with HFpEF underwent cardiopulmonary exercise testing with echocardiography, with a particular focus on mitral regurgitation (MR) severity assessment in rest and during exercise. Longitudinal follow-up included cardiovascular hospitalizations and all-cause mortality.

Results: The study involved 429 patients with HFpEF (age 74 ± 8years, 65% female). AFMR was observed in 35% of patients at rest (24% mild, 11% ≥ moderate). Increasing AFMR severity correlated with atrial fibrillation, larger left atrium volumes, reduced left atrial function, lower peak oxygen consumption, and increased exercise-induced pulmonary hypertension. After adjusting for age, sex, ventricular and atrial volume and function, moderate or severe MR remained linked with worse outcomes (HR: 4.03; 95% CI: 2.26-7.21; P < 0.001). During exercise, MR severity increased in 12% of patients based on guideline-based thresholds. Notably, even in patients without formal reclassification, an absolute increase in effective regurgitant orifice area ≥5 mm² during exercise was independently predictive of adverse outcomes (HR: 2.43; 95% CI 1.34-4.41; P = 0.004). This increase was not related to systemic blood pressure, chronotropic incompetence, or left ventricular dysfunction.

Conclusions: AFMR is common in HFpEF and independently associated with adverse outcomes when moderate or severe at rest. Even mild, exercise-induced increases carry additional prognostic value, underscoring the relevance of both resting and dynamic AFMR assessment.

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保留射血分数的心力衰竭患者心房功能性二尖瓣返流和运动诱发的变化。

背景：心房功能性二尖瓣反流（AFMR）在保留射血分数（HFpEF）的心力衰竭患者中普遍存在，并与不良结局相关，但这种双向关联仍未得到充分探讨。目的：本研究的目的是阐明静息和运动时AFMR在HFpEF中的病理生理和预后意义。方法：在这项多中心队列研究中，连续的HFpEF患者通过超声心动图进行心肺运动试验，特别关注休息和运动期间二尖瓣反流（MR）严重程度的评估。纵向随访包括心血管住院和全因死亡率。结果：本研究纳入429例HFpEF患者（年龄74±8岁，65%为女性）。35%的患者在休息时观察到AFMR（24%轻度，11%≥中度）。AFMR严重程度的增加与心房颤动、左心房容量增大、左心房功能降低、峰值耗氧量降低和运动性肺动脉高压升高相关。在调整了年龄、性别、心室和心房容积和功能后，中度或重度MR仍然与较差的结果相关（HR: 4.03; 95% CI: 2.26-7.21; P < 0.001）。在运动期间，基于指南的阈值，12%的患者MR严重程度增加。值得注意的是，即使在没有正式重新分类的患者中，运动期间有效反流口面积≥5 mm2的绝对增加也是不良结局的独立预测因素（HR: 2.43; 95% CI 1.34-4.41; P = 0.004）。这种增加与全身血压、变时功能不全或左心室功能不全无关。结论：AFMR在HFpEF中很常见，并且在休息时与中度或重度不良结局独立相关。即使是轻微的运动引起的增加也具有额外的预后价值，强调静息和动态AFMR评估的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.