Cioffi Giovanni, Tarantini Luigi, De Feo Stefania, Pulignano Giovanni, Del Sindaco Donatella, Stefenelli Carlo, Di Lenarda Andrea, Opasich Cristina
Department of Cardiology, Villa Bianca Hospital, Trento, Italy.
Eur J Heart Fail. 2005 Dec;7(7):1112-7. doi: 10.1016/j.ejheart.2005.01.016.
Mitral regurgitation (MR) has been demonstrated to be a powerful predictor of adverse outcome in middle-aged patients with chronic heart failure (CHF). In this study, we sought to define the prognostic impact of functional mitral regurgitation in a population of elderly patients with systolic CHF.
One hundred seventy-five outpatients aged >70 years with validated CHF and left ventricular ejection fraction <40% underwent clinical and echocardiographic evaluations at baseline. Mitral regurgitation was diagnosed by Color Doppler and quantified in 5 categorical values using a 0-4+ grading system. Outcome measures included 1-year mortality and hospitalization for worsening CHF.
The distribution of patients according to the 5 different degrees of MR detected at baseline was: absent=11%, 1+=31%, 2+=38%, 3+=16%, 4+=4%. The relationship between MR and mortality was direct and approximately linear (r=0.39, p=0.00001). The prevalence of death in the 5 subgroups was 0%, 7%, 15%, 45%, 57%, respectively. Multivariate logistic regression analysis showed that MR was the strongest predictor of death (OR 4.47, 95% CI 1.50-13.0), independently of the presence of diabetes mellitus, older age and larger left ventricular end-diastolic volume. No association was found between MR and hospitalization for worsening CHF (r=0.08, p=0.41).
This study establishes the direct and independent relationship between MR severity and one-year mortality among elders with systolic CHF. Conversely, MR does not provide useful information regarding the risk of subsequent hospitalization for worsening CHF.
二尖瓣反流（MR）已被证明是中年慢性心力衰竭（CHF）患者不良预后的有力预测指标。在本研究中，我们试图确定功能性二尖瓣反流对老年收缩性CHF患者群体的预后影响。
175例年龄>70岁、经证实患有CHF且左心室射血分数<40%的门诊患者在基线时接受了临床和超声心动图评估。通过彩色多普勒诊断二尖瓣反流，并使用0-4+分级系统将其量化为5个分类值。观察指标包括1年死亡率和因CHF恶化而住院的情况。
根据基线时检测到的5种不同程度的MR，患者分布情况如下：无反流=11%，1+级=31%，2+级=38%，3+级=16%，4+级=4%。MR与死亡率之间呈直接且近似线性的关系（r=0.39，p=0.00001）。5个亚组中的死亡率分别为0%、7%、15%、45%、57%。多因素逻辑回归分析表明，MR是死亡的最强预测因素（OR 4.47，95%CI 1.50-13.0），独立于糖尿病、高龄和较大的左心室舒张末期容积。未发现MR与因CHF恶化而住院之间存在关联（r=0.08，p=0.41）。
本研究确立了老年收缩性CHF患者中MR严重程度与1年死亡率之间的直接和独立关系。相反，MR对于CHF恶化导致后续住院风险并无有用信息。
