BACKGROUND Two subtypes of atrial functional mitral regurgitation (AFMR) have been described, one is characterized by Carpentier type I and the other by Carpentier type IIIb leaflet motion. OBJECTIVES The authors sought to analyze echocardiographic characteristics and outcomes of AFMR subtypes undergoing mitral valve transcatheter edge-to-edge repair (M-TEER). METHODS Of 1,047 consecutive patients who underwent M-TEER, the authors identified those with isolated mitral annulus dilation (Carpentier I), termed AFMR-IAD, and those with atriogenic hamstringing characterized by restricted posterior mitral leaflet motion (Carpentier IIIb), termed AFMR-AH. Echocardiographic baseline characteristics and outcomes up to 1-year were analyzed. RESULTS A total of 128 patients (12.2%) met AFMR criteria; 75 (58.6%) were identified as AFMR-IAD and 53 (41.4%) as AFMR-AH. AFMR-AH displayed greater left atrial and left ventricular volumes, greater mitral annulus, shorter and steeper posterior mitral leaflet, and more pronounced MR (all P < 0.05). Technical success was achieved in 98.7% (AFMR-IAD) and 86.8% (AFMR-AH) of patients (P = 0.009). At discharge, device detachments were exclusively observed in AFMR-AH (10.0%). MR ≤II was achieved in 95.6% and 78.6% at 30 days (P = 0.009) and in 93.0% and 74.1% at 1 year (P = 0.038) in patients with AFMR-IAD and AFMR-AH, respectively. AFMR-AH was associated with procedural failure (OR: 1.17 [95% CI: 1.00-1.38]; P = 0.045) at 30 days (43.4% vs 24.0%; P = 0.023) and all-cause mortality (HR: 2.54 [95% CI: 1.09-5.91]; P = 0.031) at 1 year (77% vs 92%, Kaplan-Meier estimated 1-year survival; P = 0.017). CONCLUSIONS AFMR-AH shows worse procedural and clinical outcomes following M-TEER than AFMR-IAD. Thus, vigilance regarding this pathology is warranted and alternative mitral valve therapies might need to be considered.

中文翻译：

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接受经导管边对边修复的心房功能性二尖瓣反流亚型：心房源性腿筋损伤的次优结果。


背景技术已经描述了心房功能性二尖瓣反流(AFMR)的两种亚型，一种以Carpentier I型为特征，另一种以Carpentier IIIb型小叶运动为特征。目的 作者试图分析接受二尖瓣经导管边对边修复术 (M-TEER) 的 AFMR 亚型的超声心动图特征和结果。方法 在连续 1,047 名接受 M-TEER 的患者中，作者确定了那些患有孤立性二尖瓣环扩张 (Carpentier I) 的患者，称为 AFMR-IAD，以及那些以二尖瓣后叶运动受限为特征的心房源性腘绳肌腱炎 (Carpentier IIIb) 的患者，称为 AFMR-啊。分析了长达 1 年的超声心动图基线特征和结果。结果 共有128例患者（12.2%）符合AFMR标准； 75 例 (58.6%) 被鉴定为 AFMR-IAD，53 例 (41.4%) 被鉴定为 AFMR-AH。 AFMR-AH 显示更大的左心房和左心室容积、更大的二尖瓣环、更短且更陡的二尖瓣后叶以及更明显的 MR（所有 P < 0.05）。 98.7% (AFMR-IAD) 和 86.8% (AFMR-AH) 的患者取得了技术成功 (P = 0.009)。出院时，仅在 AFMR-AH 中观察到装置脱离（10.0%）。 AFMR-IAD 和 AFMR-AH 患者在 30 天时达到 MR ≤ II 的比例分别为 95.6% 和 78.6% (P = 0.009)，在 1 年时达到 MR ≤ II 的比例分别为 93.0% 和 74.1% (P = 0.038)。 AFMR-AH 与 30 天时手术失败（OR：1.17 [95% CI：1.00-1.38]；P = 0.045）（43.4% vs 24.0%；P = 0.023）和全因死亡率（HR：2.54 [ 95% CI：1.09-5.91]；P = 0.031）1 年时（77% vs 92%，Kaplan-Meier 估计的 1 年生存率；P = 0.017）。结论 AFMR-AH 显示 M-TEER 后的手术和临床结果比 AFMR-IAD 更差。 因此，需要对这种病理保持警惕，并且可能需要考虑替代二尖瓣疗法。