Agricola Eustachio, Ielasi Alfonso, Oppizzi Michele, Faggiano Pompilio, Ferri Luca, Calabrese Alice, Vizzardi Enrico, Alfieri Ottavio, Margonato Alberto
Division of Non-Invasive Cardiology, San Raffaele Hospital, 20132 Milano, Italy.
Eur J Heart Fail. 2009 Jun;11(6):581-7. doi: 10.1093/eurjhf/hfp051. Epub 2009 Apr 27.
To assess long-term prognosis in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction, receiving current standard pharmacological therapy.
We prospectively enrolled 404 consecutive patients (mean age 70.2 +/- 10 years) with ischaemic (76.5%) and non-ischaemic (23.5%) LV dysfunction (ejection fraction 34.4 +/- 10.8%) and at least mild MR. Results are reported at 4 years' follow-up. Survival free of all-cause mortality was 53% and cardiac death was 74%. Survival free of all-cause mortality was 50% (95% CI 35-72) for patients with moderate MR, 49% (95% CI 27-65) for severe MR, and 64% (95% CI 47-78) for mild MR (P = 0.03). Survival free of cardiac death was 57% (95% CI 38-74) for patients with moderate MR, 55% (95% CI 30-77) for severe MR, and 94% (95% CI 59-98) for mild MR (P = 0.003). Moderate-to-severe MR [relative risk (RR) 2.7, 95% CI 1.2-6.1, P = 0.003] was an independent predictor of cardiac death but not of all-cause mortality. Survival free of heart failure (HF) was 32%. Survival free of HF was 20% (95% CI 17-35) for patients with moderate MR, 18% (95% CI 15-32) for severe MR, and 62% (95% CI 45-72) for mild MR (P = 0.0001). Moderate-to-severe MR (RR 3.2, 95% CI 1.9-5.2, P = 0.0001) was an independent predictor of HF.
The mortality and morbidity of patients with LV dysfunction and FMR remain high despite current standard pharmacological therapy. Moderate-to-severe MR is an independent predictor of cardiac death and HF.
评估接受当前标准药物治疗的功能性二尖瓣反流（FMR）和左心室（LV）功能障碍患者的长期预后。
我们前瞻性纳入了404例连续患者（平均年龄70.2±10岁），这些患者存在缺血性（76.5%）和非缺血性（23.5%）左心室功能障碍（射血分数34.4±10.8%）且至少有轻度二尖瓣反流。在4年随访时报告结果。全因死亡率生存情况为53%，心源性死亡为74%。中度二尖瓣反流患者全因死亡率生存情况为50%（95%可信区间35 - 72），重度二尖瓣反流患者为49%（95%可信区间27 - 65），轻度二尖瓣反流患者为64%（95%可信区间47 - 78）（P = 0.03）。中度二尖瓣反流患者心源性死亡生存情况为57%（95%可信区间38 - 74），重度二尖瓣反流患者为55%（95%可信区间30 - 77），轻度二尖瓣反流患者为94%（95%可信区间59 - 98）（P = 0.003）。中重度二尖瓣反流[相对风险（RR）2.7，95%可信区间1.2 - 6.1，P = 0.003]是心源性死亡的独立预测因素，但不是全因死亡率的独立预测因素。无心力衰竭（HF）生存情况为32%。中度二尖瓣反流患者无心力衰竭生存情况为20%（95%可信区间17 - 35），重度二尖瓣反流患者为18%（95%可信区间15 - 32），轻度二尖瓣反流患者为62%（95%可信区间45 - 72）（P = 0.0001）。中重度二尖瓣反流（RR 3.2，95%可信区间1.9 - 5.2，P = 0.0001）是心力衰竭的独立预测因素。
尽管有当前标准药物治疗，但左心室功能障碍和FMR患者的死亡率和发病率仍然很高。中重度二尖瓣反流是心源性死亡和心力衰竭的独立预测因素。
