Mast S T, Gersing K R, Anstrom K J, Krishnan K R, Califf R M, Jollis J G
Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
Am J Cardiol. 2001 Apr 15;87(8):989-93: A4. doi: 10.1016/s0002-9149(01)01435-7.
The identification of an association between fenfluramines and valvular disease has raised the possibility of a similar association between another class of medications that increases local levels of serotonin, the selective serotonin-reuptake inhibitors (SSRIs). The objective of this study was to examine the association between heart valve regurgitation and treatment with SSRIs. We examined 5,437 consecutive patients who underwent echocardiography. Patients with a similar likelihood of SSRI treatment were identified by propensity models. The prevalence of regurgitation according to treatment was compared after adjusting for clinical characteristics associated with regurgitation. We also blindly reinterpreted a subset of 2,000 echocardiograms to identify characteristics associated with fenfluramine-associated valvular heart disease such as posterior mitral leaflet restriction. Among 5,437 consecutively hospitalized patients, we identified 292 who had taken SSRIs before admission. Patients taking SSRIs tended to be younger, female, Caucasian, unmarried, and more likely to have psychiatric illness and hypertension (p < or = 0.05). The overall prevalence of regurgitation meeting Food and Drug Administration criteria (at least moderate mitral regurgitation or mild aortic regurgitation) was 30%, with no significant difference in prevalence between those receiving SSRIs (26.7%) and controls (30.4%) (p = 0.19). The association remained negative when comparing SSRI-treated patients to controls with similar characteristics. Furthermore, the prevalence of features described in conjunction with fenfluramine exposure, such as posterior mitral leaflet restriction, was not higher in SSRI-treated patients. Among a large consecutive cohort of patients, the prevalence of mitral and aortic regurgitation in patients taking SSRIs was not different from that of controls, suggesting that SSRIs are not associated with valvular disease.
芬氟拉明与瓣膜病之间关联的发现，引发了另一类可提高局部血清素水平的药物（即选择性血清素再摄取抑制剂，SSRIs）存在类似关联的可能性。本研究的目的是检验心脏瓣膜反流与SSRIs治疗之间的关联。我们检查了5437例连续接受超声心动图检查的患者。通过倾向模型确定接受SSRI治疗可能性相似的患者。在调整与反流相关的临床特征后，比较根据治疗情况得出的反流患病率。我们还对2000份超声心动图的一个子集进行了盲法重新解读，以确定与芬氟拉明相关的瓣膜性心脏病相关的特征，如二尖瓣后叶受限。在5437例连续住院患者中，我们确定了292例入院前服用过SSRIs的患者。服用SSRIs的患者往往更年轻、为女性、白种人、未婚，且更有可能患有精神疾病和高血压（p≤0.05）。符合美国食品药品监督管理局标准的反流（至少中度二尖瓣反流或轻度主动脉反流）总体患病率为30%，接受SSRIs治疗的患者（26.7%）与对照组（30.4%）之间的患病率无显著差异（p = 0.19）。将接受SSRI治疗的患者与具有相似特征的对照组进行比较时，该关联仍为阴性。此外，在接受SSRI治疗的患者中，与芬氟拉明暴露相关描述的特征患病率，如二尖瓣后叶受限，并不更高。在一大组连续的患者队列中，服用SSRIs的患者二尖瓣和主动脉反流的患病率与对照组无异，这表明SSRIs与瓣膜病无关。
