作者：丁小涵1，2，徐御政1，卞士柱1

单位：

1.400037重庆市，陆军军医大学第二附属医院心血管内科　2.730000甘肃省兰州市，联勤保障部队第九四〇医院干部病房

Units：

1.Department of Cardiology, the Second Affiliated Hospital, Army Medical University, Chongqing 400037, China2.Department of Health Care and Geriatrics, the 940th Hopital of Joint Logistics Support Force of Chinese People's LiberationArmy, Lanzhou 730000, China

关键词：

心力衰竭；二尖瓣闭锁不全；二尖瓣反流；临床管理；指南

Keywords：

Heart failure; Mitral valve insufficiency; Mitral regurgitation; Clinical management; Guidebook

CLC：

541.62

DOI：

10.12114/j.issn.1008-5971.2022.00.243

Funds：

国家自然科学基金资助项目（81901916）；重庆市自然科学基金面上项目（cstc2019jcyj-sxmX0576）；军队后勤科研项目（18QNP002）

摘要：

继发性二尖瓣反流（SMR）是多种心脏疾病共同的重要合并症，因其改变了血流动力学，不仅加重了原发心脏疾病病情，还导致心血管疾病不良预后。随着以MitraClip为代表的SMR介入治疗技术的飞速发展，SMR的临床诊治已发生了革命性改变。然而，对于心力衰竭继发二尖瓣反流的临床诊治，目前尚无正式的临床诊治指南或共识。2021年，欧洲心脏协会（ESC）的心力衰竭协会（HFA）、欧洲心血管影像协会（EACVI）、欧洲心脏节律协会（EHRA）以及欧洲经皮心血管介入治疗协会（EAPCI）联合发布了《2021 HFA/EACVI/EHRA/EAPCI立场声明：心力衰竭患者继发二尖瓣反流的管理》，这是世界范围内首次对心力衰竭继发二尖瓣反流临床管理进行的正式立场声明。本文从心力衰竭继发二尖瓣反流的临床流行、病理生理学机制、临床初步评价和影像学检查方法、临床管理过程和治疗决策方面对该声明进行详细阐述和解读，以期为心力衰竭继发二尖瓣反流的临床诊治提供实用性的指导。

Abstract：

Secondary mitral regurgitation (SMR) is an important comorbidity common to a variety of heart diseases.Because of its altered hemodynamics, it not only aggravates the condition of the primary heart disease, but also leads to a poorprognosis of cardiovascular disease. With the rapid development of SMR interventional treatment technology represented byMitraClip, the clinical diagnosis and treatment of SMR has undergone revolutionary changes. However, there is no formal clinicalguidelines or consensus on the clinical diagnosis and treatment of mitral regurgitation secondary to heart failure. In 2021, the HeartFailure Association (HFA) , European Association of Cardiovascular Imaging (EACVI) , European Heart Rhythm Association(EHRA) , and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Heart Association(ESC) jointly issued the Management of Secondary Mitral Regurgitation in Patients with Heart Failure: a Joint Position Statementfrom the HFA, EACVI, EHRA, and EAPCI of the ESC . This is the first official position statement worldwide on the clinicalmanagement of mitral regurgitation secondary to heart failure. This article elaborates and interprets this statement in terms of theclinical prevalence, pathophysiological mechanisms, clinical preliminary evaluation and imaging methods, clinical managementprocess and treatment decision-making of mitral regurgitation secondary to heart failure, in order to provide practical guidance forthe clinical diagnosis and treatment of mitral regurgitation secondary to heart failure.

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