Krauss Juan, Pizarro Rodolfo, Oberti Pablo F, Falconi Mariano, Cagide Arturo
Cardiology Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Am Heart J. 2006 Nov;152(5):1004.e1-8. doi: 10.1016/j.ahj.2006.01.015.
To date, few studies have evaluated asymptomatic patients with organic mitral regurgitation (MR). The goal of the present study was to assess the presence of independent predictive factors for progression of symptoms and/or left ventricular dysfunction (SLVSD) in this population.
We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% men; ejection fraction 66 +/- 3%) who were asymptomatic, with severe organic MR. Mean follow-up was 29 +/- 12 months. The combined end point was SLVSD. Clinical and echocardiographic variables were evaluated. Follow-up data were also estimated considering the annualized rate (?) of the echocardiographic indices.
Thirty-seven patients (29%) had SLVSD during follow-up. Cox regression model identified the effective regurgitant orifice area (EROA) >55 mm2 (risk ratio 6.3, 95% CI 2.3-8.1, P < .001) and end-systolic diameter >22 mm/m2 (risk ratio 4.5, 95% CI, 1.8-9.4, P < .02) as the only independent predictors of SLVSD. When the follow-up data were added, the ?EROA (>15 mm2/y) was independently associated with the end point.
In asymptomatic patients with organic MR, the EROA and the end-systolic diameter are independent predictors of SLVSD and allow a better risk stratification in this group of patients. ANALYTICAL SUMMARY: The goal of this study was to determine the presence of independent predictors of symptomatic progression, and/or left ventricular dysfunction in asymptomatic patients with severe mitral regurgitation. We prospectively evaluated 128 consecutive patients (mean age 60 +/- 8 years, 68% male; ejection fraction 66 +/- 3%). During follow-up (mean 29 +/- 12 months). The end point occurred in 37 patients (29%). Multivariate analysis using Cox model identified the effective regurgitant orifice area (EROA) >55 mm2 (RR: 6.3; 95% CI: 2.3-8.1; P < .001) and an end-systolic diameter (ESD) >22 mm/m2 (RR: 4.5; 95%CI: 1.8-9.4; P < .02) as the only independent predictors of the end point. When the follow-up data were added, the annualized change rate of the EROA (>15 mm2/year) was independently associated with the end point. In asymptomatic patients with organic mitral regurgitation, the EROA and ESD at study entry were independent predictors of the combined end point and allowed a better risk stratification in this group of patients.
迄今为止，很少有研究评估无症状的器质性二尖瓣反流（MR）患者。本研究的目的是评估该人群中症状进展和/或左心室功能障碍（SLVSD）的独立预测因素。
我们前瞻性评估了128例连续的无症状严重器质性MR患者（平均年龄60±8岁，68%为男性；射血分数66±3%）。平均随访时间为29±12个月。联合终点为SLVSD。评估了临床和超声心动图变量。还根据超声心动图指标的年化率（？）估计了随访数据。
37例患者（29%）在随访期间出现SLVSD。Cox回归模型确定有效反流口面积（EROA）>55 mm²（风险比6.3，95%可信区间2.3 - 8.1，P <.001）和收缩末期直径>22 mm/m²（风险比4.5，95%可信区间1.8 - 9.4，P <.02）是SLVSD的唯一独立预测因素。加入随访数据后，EROA的年化变化率（>15 mm²/年）与终点独立相关。
在无症状的器质性MR患者中，EROA和收缩末期直径是SLVSD的独立预测因素，有助于对该组患者进行更好的风险分层。分析总结：本研究的目的是确定无症状严重二尖瓣反流患者症状进展和/或左心室功能障碍的独立预测因素。我们前瞻性评估了128例连续患者（平均年龄60±8岁，68%为男性；射血分数66±3%）。在随访期间（平均29±12个月）。37例患者（29%）出现终点事件。使用Cox模型的多变量分析确定有效反流口面积（EROA）>55 mm²（RR：6.3；95%可信区间：2.3 - 8.1；P <.001）和收缩末期直径（ESD）>22 mm/m²（RR：4.5；95%可信区间：1.8 - 9.4；P <.02）是终点事件的唯一独立预测因素。加入随访数据后，EROA的年化变化率（>15 mm²/年）与终点独立相关。在无症状的器质性二尖瓣反流患者中，研究开始时的EROA和ESD是联合终点的独立预测因素，有助于对该组患者进行更好的风险分层。
