Rifaie Osama, Esmat Iman, Abdel-Rahman Mohamed, Nammas Wail
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Echocardiography. 2009 Feb;26(2):119-27. doi: 10.1111/j.1540-8175.2008.00774.x.
The assessment of patients with mitral stenosis before percutaneous balloon mitral valvuloplasty (PBMV) is crucial to predict outcome after the procedure. We tried to explore the prognostic power of a novel echocardiographic score to predict immediate postprocedural outcome in comparison to the standard score.
We enrolled 50 consecutive patients with moderate to severe mitral stenosis admitted to undergo PBMV. For all patients, we assessed both the standard Massachusetts General Hospital (MGH) score and a novel score based on calcification (especially commissural) and subvalvular involvement. Patients underwent PBMV with the double balloon technique. Thereafter, patients were classified into two groups: group 1 (poor outcome) defined as no procedural success and/or increase of MR by more than 1 grade and group 2 (optimal outcome) defined as procedural success with increase of MR by 1 grade or less.
The total MGH score did not differ significantly between the two groups. However, among the individual parameters of the score, both calcification and subvalvular affection were significantly higher in group 1 versus group 2 (2.8 +/- 0.4 versus 1.7 +/- 0.8, and 2.4 +/- 0.5 versus 1.6 +/- 0.4, respectively, P < 0.01 for both). The total novel score and its two individual parameters (calcification and subvalvular involvement) were all significantly higher in group 1 versus group 2 (6 +/- 1.5 versus 2.9 +/- 1.9, 4.9 +/- 1.2 versus 2.4 +/- 1.5, 1.5 +/- 1.6 versus 0.5 +/- 0.9, respectively, P < 0.01 for all). Multivariate analysis demonstrated the novel score to be the only independent predictor of poor outcome.
The novel score is more reliable and correlates with outcome better than the standard score.
经皮二尖瓣球囊成形术（PBMV）前对二尖瓣狭窄患者进行评估对于预测术后结果至关重要。我们试图探究一种新的超声心动图评分与标准评分相比预测术后即刻结果的预后能力。
我们纳入了50例连续入院接受PBMV的中重度二尖瓣狭窄患者。对所有患者，我们评估了标准的麻省总医院（MGH）评分以及基于钙化（尤其是瓣叶联合处）和瓣下受累情况的新评分。患者采用双球囊技术进行PBMV。此后，患者被分为两组：第1组（预后不良）定义为手术未成功和/或二尖瓣反流（MR）增加超过1级，第2组（预后良好）定义为手术成功且MR增加1级或更少。
两组间MGH总分无显著差异。然而，在该评分的各个参数中，第1组的钙化和瓣下病变均显著高于第2组（分别为2.8±0.4对1.7±0.8，以及2.4±0.5对1.6±0.4，两者P均<0.01）。第1组的新评分总分及其两个单独参数（钙化和瓣下受累）均显著高于第2组（分别为6±1.5对2.9±1.9，4.9±1.2对2.4±1.5，1.5±1.6对0.5±0.9，所有P均<0.01）。多因素分析表明新评分是预后不良的唯一独立预测因素。
新评分比标准评分更可靠且与结果的相关性更好。
