Baskett Roger J F, Exner Derek V, Hirsch Gregory M, Ghali William A
Maritime Heart Centre and the Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Can J Cardiol. 2007 Aug;23(10):797-800. doi: 10.1016/s0828-282x(07)70830-9.
Mitral insufficiency is known to occur in a substantial proportion of patients with heart failure. Its relationship with morbidity and mortality is poorly described.
The mortality and hospitalization for heart failure were retrospectively examined in patients who underwent baseline echocardiography in the Studies Of Left Ventricular Dysfunction (SOLVD) treatment and prevention trials. The presence and grade of mitral insufficiency was assessed, and patients with and without mitral insufficiency were compared.
Patients with left ventricular dysfunction and mitral insufficiency had greater than twofold increased risk of death or admission for heart failure over two years (RR 2.38, 95% CI 1.43 to 3.97). This excess risk persisted after adjustment for the severity of heart failure, etiology and differences in treatment (RR 1.82, 95% CI 1.04 to 3.17; P=0.04). The presence of moderate mitral insufficiency versus no insufficiency was associated with even greater independent risk (RR 2.20, 95% CI 1.01 to 4.80; P=0.05). Results were consistent with binary and ordinal analysis of mitral insufficiency.
The presence of mitral insufficiency in patients with left ventricular dysfunction is independently associated with adverse outcomes, including death and hospitalization for heart failure. This has potentially important clinical implications for the assessment and management of patients with heart failure.
已知相当一部分心力衰竭患者会出现二尖瓣关闭不全。其与发病率和死亡率的关系描述甚少。
在左心室功能障碍研究（SOLVD）治疗和预防试验中，对接受基线超声心动图检查的患者的心力衰竭死亡率和住院情况进行回顾性研究。评估二尖瓣关闭不全的存在情况和分级，并对有和无二尖瓣关闭不全的患者进行比较。
左心室功能障碍合并二尖瓣关闭不全的患者在两年内死亡或因心力衰竭入院的风险增加了两倍多（风险比2.38，95%置信区间1.43至3.97）。在对心力衰竭严重程度、病因和治疗差异进行调整后，这种额外风险仍然存在（风险比1.82，95%置信区间1.04至3.17；P = 0.04）。存在中度二尖瓣关闭不全与无关闭不全相比，具有更大的独立风险（风险比2.20，95%置信区间1.01至4.80；P = 0.05）。结果与二尖瓣关闭不全的二元和有序分析一致。
左心室功能障碍患者存在二尖瓣关闭不全与不良结局独立相关，包括死亡和因心力衰竭住院。这对心力衰竭患者的评估和管理具有潜在的重要临床意义。
