The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC
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- Andrew J S Coats
- Warwick Medical School, University of Warwick , Coventry, UK
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- Stefan D Anker
- Department of Cardiology (CVK) , Germany
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- Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Yale University School of Medicine , New Haven, USA
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- Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute , Milan, Italy
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- Ralph Stephan von Bardeleben
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center , Mainz, Germany
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- Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School , Hannover, Germany
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- Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre , Leiden, The Netherlands
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- Serge Boveda
- Department of Cardiology, Clinique Pasteur , 31076 Toulouse, France
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- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius, Lithuania
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- John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow , Glasgow, UK
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- Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Leipzig, Germany
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- Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology , Germany
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- Dimitrios Farmakis
- University of Cyprus Medical School , Nicosia, Cyprus
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- Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens , Athens, Greece
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- Jörg Hausleiter
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich , Germany
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- Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig , Leipzig, Germany
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- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital , Wroclaw, Poland
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- Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota , Murska Sobota, Slovenia
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- Christoph Leclercq
- Université de Rennes I, CICIT 804 , Rennes, CHU Pontchaillou, France , Rennes
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- Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital , Stockholm, Sweden
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- Theresa McDonagh
- King's College Hospital , London, UK
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- Mandeep R Mehra
- Brigham Women's Hospital Heart and Vascular Center and the Center of Advanced Heart Disease, Harvard Medical School , Boston, USA
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- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Italy
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- Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel, Centre d'Investigation Clinique, Filière Insuffisance Cardiaqu , e, France, Lyon
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- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel , Switzerland
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- Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk, Belgium
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- Claudio Muneretto
- School of Cardiac Surgery, University of Brescia , Italy
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- Jean-Francois Obadia
- Department of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital , Lyon, France
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- Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital , Wroclaw, Poland
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- Fabien Praz
- Department of Cardiology, Inselspital, University of Bern , Bern, Switzerland
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- Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum , Bad Oeynhausen, Germany
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- Frank Ruschitzka
- Cardiology Clinic, University Heart Center, University Hospital Zürich , Switzerland
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- Alec Vahanian
- University of Paris , Paris, France
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- Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern , Bern, Switzerland
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- Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal , Madrid, Spain
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- Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet , Oslo, Norway
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- Hein Heidbuchel
- Antwerp University and Antwerp University Hospital , Antwerp, Belgium
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- Petar M Seferovic
- Faculty of Medicine, University of Belgrade , Belgrade, Serbia
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- Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital , Westminster Bridge Road, London, UK
説明
<jats:title>Abstract</jats:title><jats:p>Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology—the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)—presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.</jats:p>
収録刊行物
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- European Heart Journal
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European Heart Journal 42 (13), 1254-1269, 2021-03-18
Oxford University Press (OUP)