Mezilis N E, Salame M Y, Oakley G D
Cardiology Department, Northern General Hospital, Sheffield, U.K.
Clin Cardiol. 1999 Jul;22(7):453-8. doi: 10.1002/clc.4960220704.
Percutaneous balloon mitral valvotomy (PBMV) has become the procedure of choice for many patients with symptomatic mitral stenosis. However, the development of significant mitral regurgitation (MR) remains an infrequent but very important complication. The echocardiographic scoring system described by Padial et al. has been successful in predicting the development of severe MR following PBMV using the double balloon technique.
We aimed to assess the applicability of this new scoring system in predicting a significant increase in MR with the Inoue balloon and to compare it with the established Wilkins score.
The echocardiograms of 23 patients who had undergone PBMV for symptomatic mitral stenosis were analyzed retrospectively using both scoring systems, and the severity of MR was determined from pre- and postprocedural studies.
Post PBMV, significant MR occurred in four patients (17%) while severe MR occurred in two patients (9%). Padial scores [mean (standard error of the mean)] in the group of patients with and without significant MR were [9.1 (0.8)] and [6.0 (0.3)], respectively (p = 0.002), while the Wilkins score was [7.5 (1.0)] and [6.4 (0.5)], respectively (p = 0.3). Using 8 as a cutoff point, the sensitivity and specificity of the newer scoring system was 83 and 100%, respectively, while the sensitivity and specificity of the Wilkins score was 50 and 50%, respectively. The positive predictive value > 8 was 100% (4/4) for the Padial and 25% (1/4) for the Wilkins system. Accordingly, the negative predictive value < 8 was 89% (17/19) for the Padial and 73% (14/19) for the Wilkins system.
The newer scoring system is better at reliably identifying patients at risk of developing significant MR from PBMV with the Inoue balloon.
经皮球囊二尖瓣成形术（PBMV）已成为许多有症状二尖瓣狭窄患者的首选治疗方法。然而，严重二尖瓣反流（MR）的发生仍然是一种少见但非常重要的并发症。Padial等人描述的超声心动图评分系统已成功地使用双球囊技术预测PBMV后严重MR的发生。
我们旨在评估这种新评分系统在预测使用Inoue球囊时MR显著增加方面的适用性，并将其与既定的Wilkins评分进行比较。
对23例因有症状二尖瓣狭窄接受PBMV治疗的患者的超声心动图进行回顾性分析，同时使用两种评分系统，并根据术前和术后研究确定MR的严重程度。
PBMV术后，4例患者（17%）出现严重MR，2例患者（9%）出现重度MR。有和没有严重MR的患者组的Padial评分[平均值（平均标准误差）]分别为[9.1（0.8）]和[6.0（0.3）]（p = 0.002），而Wilkins评分为[7.5（1.0）]和[6.4（0.5）]，分别（p = 0.3）。以8为切点，新评分系统的敏感性和特异性分别为83%和100%，而Wilkins评分的敏感性和特异性分别为50%和50%。Padial评分>8的阳性预测值为100%（4/4），Wilkins系统为25%（1/4）。因此，Padial评分<8的阴性预测值为89%（17/19），Wilkins系统为73%（14/19）。
新的评分系统在可靠识别使用Inoue球囊进行PBMV后有发生严重MR风险的患者方面表现更佳。
