secondary mitral regurgitation in heart failure pathophysiology, prognosis, and therapeutic considerations外文参考.pdf

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ,,2015
ª 2015 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 0735-1097/$
PUBLISHED BY ELSEVIER INC. /
THE PRESENT AND FUTURE
STATE-OF-THE-ART REVIEW
Secondary Mitral Regurgitation
in Heart Failure
Pathophysiology, Prognosis, and Therapeutic Considerations
Anita W. Asgar, MD,* Michael J. Mack, MD,y Gregg W. Stone, MDz
ABSTRACT
The development of secondary mitral regurgitation (MR) due to left ventricular dysfunction, also known as functional
MR, is strongly associated with a poor prognosis in patients with heart failure. The mechanisms underlying secondary MR
are multifactorial; accurate imaging assessment of secondary MR may be challenging and nuanced; and the appropriate
roles of medical, surgical, and interventional therapies for management of secondary MR are controversial and evolving.
In this review, the pathophysiology, evaluation, and prognosis of secondary MR in patients with heart failure are dis-
cussed, and we evaluate in detail the evidence for the various therapeutic approaches for secondary MR, including
guideline-directed medication for left ventricular dysfunction, cardiac resynchronization therapy and revascularization
when appropriate, and mitral valve surgery and transcatheter interventions. The role of a multidisciplinary heart team in
determining the optimal management strategy for secondary MR is also discussed. (J Am Coll Cardiol 2015;65:1231–48)
© 2015 by the American College of Cardiology Foundation.
itral regurgitation (MR) is among the most etiology, pathophysiology, prognostic implications,
M common valvular heart disorders, with an and diagnosis of