Mitral regurgitation (MR) is highly prevalent among patients with heart failure and preserved ejection fraction (HFpEF). Despite this combination being closely associated with unfavourable outcomes, it remains relatively understudied. This is partly due to the inherent heterogeneity of patients with HFpEF. To address this gap, dissecting HFpEF into mechanism-based phenotypes may offer a promising avenue for advancing our comprehension of these complex intertwined conditions. This review employs the validated CircAdapt model to explore the haemodynamic implications of moderate to severe MR across a well-defined spectrum of myocardial disease, characterized by impaired relaxation and reduced myocardial compliance. Both heart failure and mitral valve disease share overlapping symptomatology, primarily attributed to elevated pulmonary pressures. The intricate mechanisms contributing to these elevated pressures are multifaceted, potentially influenced by diastolic dysfunction, left atrial myopathy, and MR. Accurate evaluation of the haemodynamic and clinical impact of MR necessitates a comprehensive approach, taking into account the characteristics of both the left atrium and left ventricle, as well as their intricate interactions, which may currently be underemphasized in diagnostic practice. This holistic assessment is imperative for enhancing our understanding and refining therapeutic strategies within this patient cohort.

中文翻译：

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射血分数保留的心力衰竭中的二尖瓣反流：瓣膜、心室和心房的相互作用

二尖瓣反流 (MR) 在心力衰竭和射血分数保留 (HFpEF) 患者中非常普遍。尽管这种组合与不利结果密切相关，但其研究仍然相对不足。这部分是由于 HFpEF 患者固有的异质性。为了解决这一差距，将 HFpEF 分解为基于机制的表型可能为增进我们对这些复杂的相互交织的条件的理解提供一个有希望的途径。本综述采用经过验证的 CircAdapt 模型来探讨中度至重度 MR 对明确定义的心肌疾病谱的血流动力学影响，其特征是舒张受损和心肌顺应性降低。心力衰竭和二尖瓣疾病都有重叠的症状，主要归因于肺动脉压升高。导致压力升高的复杂机制是多方面的，可能受到舒张功能障碍、左心房肌病和 MR 的影响。准确评估 MR 的血流动力学和临床影响需要采用综合方法，考虑左心房和左心室的特征以及它们复杂的相互作用，而目前在诊断实践中可能没有充分重视这些相互作用。这种整体评估对于增强我们对这一患者群体的理解和完善治疗策略至关重要。