Langerveld J, Hemel N M, Ernst S M, Plokker H W, Kelder J C, Jaarsma W
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
J Heart Valve Dis. 2001 Jul;10(4):530-8.
The predictive value of chronic atrial fibrillation (AF) before percutaneous mitral balloon valvotomy (PMBV) is still under discussion. The effect of the duration of chronic AF on short- or long-term results is not known. Therefore, we analyzed the predictive value of pre-procedural chronic AF and the duration of this rhythm disturbance for short- and long-term outcome after PMBV in patients with mitral valve stenosis.
A total of 140 PMBV procedures was performed in 137 patients with severe mitral stenosis. Sixty-three patients (45%) were in chronic AF; in 40 patients (63%) the AF was of more than one year duration. A successful procedure is defined as PMBV achieved without acute mitral valve replacement, and a mitral valve area after PMBV of > or =1.5 cm2.
Patients in chronic AF were significantly older, had a larger left atrial diameter and higher NYHA functional class, compared with patients in sinus rhythm (SR). The success rates of PMBV were 80.5% and 77.6% in patients with SR and AF, respectively (p = NS). Mean follow up was 4.2+/-2.6 years (n = 127). At four years' follow up the event-free survival was 86.5% in patients with SR, and 78.5% in those with chronic AF at baseline (p = 0.031). Multivariate analysis of the entire study population showed the presence of chronic AF to be the only pre-procedural independent predictor for severe mitral regurgitation after PMBV (p = 0.030), as well for an event (p = 0.039) and restenosis (p = 0.034) during follow up. The risk for an event or restenosis during follow up increased seven-fold when chronic AF at baseline was present for more than one year (p = 0.010).
Pre-procedural chronic AF is an independent predictor for unfavorable outcome at short- and long-term follow up after PMBV. A longer duration of AF further increases the risk of an event or restenosis.
经皮二尖瓣球囊成形术（PMBV）前慢性心房颤动（AF）的预测价值仍存在争议。慢性AF持续时间对短期或长期结果的影响尚不清楚。因此，我们分析了二尖瓣狭窄患者术前慢性AF及其持续时间对PMBV术后短期和长期结局的预测价值。
对137例重度二尖瓣狭窄患者共进行了140次PMBV手术。63例患者（45%）为慢性AF；40例患者（63%）的AF持续时间超过1年。成功的手术定义为在未进行急性二尖瓣置换的情况下完成PMBV，且PMBV术后二尖瓣面积≥1.5cm²。
与窦性心律（SR）患者相比，慢性AF患者年龄显著更大，左心房直径更大，纽约心脏协会（NYHA）心功能分级更高。SR组和AF组患者的PMBV成功率分别为80.5%和77.6%（p=无显著性差异）。平均随访时间为4.2±2.6年（n=127）。在4年随访时，SR组患者无事件生存率为86.5%，基线时为慢性AF的患者无事件生存率为78.5%（p=0.031）。对整个研究人群进行多变量分析显示，慢性AF的存在是PMBV术后严重二尖瓣反流（p=0.030）、随访期间发生事件（p=0.039）和再狭窄（p=0.034）的唯一术前独立预测因素。当基线时慢性AF持续时间超过1年时，随访期间发生事件或再狭窄的风险增加7倍（p=0.010）。
术前慢性AF是PMBV术后短期和长期随访不良结局的独立预测因素。AF持续时间越长，发生事件或再狭窄的风险进一步增加。
