Grigioni F, Enriquez-Sarano M, Ling L H, Bailey K R, Seward J B, Tajik A J, Frye R L
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
J Am Coll Cardiol. 1999 Dec;34(7):2078-85. doi: 10.1016/s0735-1097(99)00474-x.
We sought to assess the incidence and determinants of sudden death (SUD) in mitral regurgitation due to flail leaflet (MR-FL).
Sudden death is a catastrophic complication of MR-FL. Its incidence and predictability are undefined.
The occurrence of SUD was analyzed in 348 patients (age 67 +/- 12 years) with MR-FL diagnosed echocardiographically from 1980 through 1994.
During a mean follow-up of 48 +/- 41 months, 99 deaths occurred under medical treatment. Sudden death occurred in 25 patients, three of whom were resuscitated. The sudden death rates at five and 10 years were 8.6 +/- 2% and 18.8 +/- 4%, respectively, and the linearized rate was 1.8% per year. By multivariate analysis, the independent baseline predictors of SUD were New York Heart Association (NYHA) functional class (p = 0.006), ejection fraction (p = 0.0001) and atrial fibrillation (p = 0.059). The yearly linearized rate of sudden death was 1% in patients in functional class I, 3.1% in class II and 7.8% in classes III and IV. However, of 25 patients who had SUD, at baseline, 10 (40%) were in functional class I, 9 (36%) were in class II and only 6 (24%) in class III or IV. In five patients (20%), no evidence of risk factors developed until SUD. In patients with an ejection fraction > or =60% and sinus rhythm, the linearized rate of SUD was not different in functional classes I and II (0.8% per year). Surgical correction of MR (n = 186) was independently associated with a reduced incidence of SUD (adjusted hazard ratio [95% confidence interval] 0.29 [0.11 to 0.72], p = 0.007).
Sudden death is relatively common in patients with MR-FL who are conservatively managed. Patients with severe symptoms, atrial fibrillation and reduced systolic function are at higher risk, but notable rates of SUD have been observed without these risk factors. Correction of MR appears to be associated with a reduced incidence of SUD, warranting early consideration of surgical repair.
我们试图评估因连枷样瓣叶导致的二尖瓣反流（MR - FL）患者心源性猝死（SUD）的发生率及决定因素。
心源性猝死是MR - FL的一种灾难性并发症。其发生率及可预测性尚不明确。
分析了1980年至1994年期间经超声心动图诊断为MR - FL的348例患者（年龄67±12岁）心源性猝死的发生情况。
在平均48±41个月的随访期间，99例患者在药物治疗下死亡。25例患者发生心源性猝死，其中3例经复苏成功。5年和10年的心源性猝死率分别为8.6±2%和18.8±4%，线性化年发生率为1.8%。多因素分析显示，心源性猝死的独立基线预测因素为纽约心脏协会（NYHA）心功能分级（p = 0.006）、射血分数（p = 0.0001）和心房颤动（p = 0.059）。心功能I级患者的心源性猝死年线性化发生率为1%，II级为3.1%，III级和IV级为7.8%。然而，在发生心源性猝死的25例患者中，基线时10例（40%）为心功能I级，9例（36%）为II级，仅6例（24%）为III级或IV级。5例患者（20%）在发生心源性猝死前无危险因素迹象。在射血分数≥60%且为窦性心律的患者中，心功能I级和II级的心源性猝死线性化发生率无差异（每年0.8%）。二尖瓣反流手术矫正（n = 186）与心源性猝死发生率降低独立相关（校正风险比[95%置信区间]0.29[0.11至0.72]，p = 0.007）。
在接受保守治疗的MR - FL患者中，心源性猝死相对常见。症状严重、有心房颤动和收缩功能降低的患者风险较高，但在无这些危险因素的患者中也观察到了显著的心源性猝死发生率。二尖瓣反流矫正似乎与心源性猝死发生率降低相关，因此有必要尽早考虑手术修复。
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