二尖瓣狭窄的年龄特异性临床和解剖学特征。

The age-specific clinical and anatomical profile of mitral stenosis.

作者信息

Ramakrishna C D, Khadar S A, George R, Jayaprakash V L, Sudhayakumar N, Jayaprakash K, Pappachan J M

机构信息

Department of Cardiology, Kottayam Medical College, Kottayam, Kerala 686008, India.

出版信息

Singapore Med J. 2009 Jul;50(7):680-5.

PMID:19644622

Abstract

INTRODUCTION

This cross-sectional study on the age-specific clinical and anatomical characteristics of mitral stenosis was conducted at the Department of Cardiology at Kottayam Medical College, South India.

METHODS

The clinical profile, laboratory details and transthoracic echocardiographical features of 203 consecutive patients with mitral stenosis were studied. Wilkins score was used to assess the valve morphology and the feasibility of balloon mitral valvotomy (BMV)/closed mitral valvotomy (CMV). Patients were grouped according to age, into Group I (younger than 40 years; 68 cases), Group II (40-65 years; 78 cases) and Group III (older than 65 years; 57 cases) for analysis.

RESULTS

The mean age of the patients was 53 years. History of rheumatic fever was less common in Group III (37 percent in Group I vs. 20 percent in Group III, p-value is equal to 0.05). Acute pulmonary oedema occurred commonly in Group III (six percent in Group I vs. 36 percent in Group III, p-value is less than 0.001). Incidence of ischaemic strokes increased with increasing age (three percent in Group I vs. 12 percent in Group II, p-value is equal to 0.05; 12 percent in Group II vs. 25 percent in Group III, p-value is equal to 0.05; and three percent in Group I vs. 25 percent in Group III, p-value is less than 0.001). Prevalence of atrial fibrillation (AF) increased progressively with increasing age (nine percent in Group I vs. 30 percent in Group II, p-value is less than 0.001; 30 percent in Group II vs. 64 percent in Group III, p-value equal to 0.003). Clinical features of pulmonary hypertension was highest among Group I (66 percent in Group I vs. 42 percent and 43 percent in Groups II and III, respectively, p-value is equal to 0.01). The mean duration of exertional dyspnoea, history of paroxysmal nocturnal dyspnoea, mean NYHA class, mean left atrial sizes, mean mitral valve areas and mean mitral valve gradients did not vary significantly among the three groups. Mitral valve scores were prohibitive for BMV/CMV in significant numbers of older patients (seven percent in Group I vs. 38 percent in Group II vs. 80 percent in Group III; p-value is less than 0.001).

CONCLUSION

When compared to the trends in developed countries, the mean age at presentation of mitral stenosis is similar, but the degree of valve deformity is higher. Incidence of pulmonary oedema, AF and stroke increases with advancing age in mitral stenosis.

摘要

引言

本横断面研究针对二尖瓣狭窄的年龄特异性临床和解剖特征，在印度南部科塔亚姆医学院心脏病科开展。

方法

对203例连续性二尖瓣狭窄患者的临床资料、实验室检查细节及经胸超声心动图特征进行研究。采用威尔金斯评分评估瓣膜形态及二尖瓣球囊成形术（BMV）/闭式二尖瓣成形术（CMV）的可行性。患者按年龄分组，分为I组（年龄小于40岁；68例）、II组（40 - 65岁；78例）和III组（年龄大于65岁；57例）进行分析。

结果

患者的平均年龄为53岁。风湿热病史在III组中较少见（I组为37%，III组为20%，p值等于0.05）。急性肺水肿在III组中常见（I组为6%，III组为36%，p值小于0.001）。缺血性卒中的发生率随年龄增长而增加（I组为3%，II组为12%，p值等于0.05；II组为12%，III组为25%，p值等于0.05；I组为3%，III组为25%，p值小于0.001）。房颤（AF）的患病率随年龄增长而逐渐增加（I组为9%，II组为30%，p值小于0.001；II组为30%，III组为64%，p值等于0.003）。肺动脉高压的临床特征在I组中最为明显（I组为66%，II组和III组分别为42%和43%，p值等于0.01）。三组间运动性呼吸困难的平均持续时间、阵发性夜间呼吸困难病史、平均纽约心脏协会（NYHA）分级、平均左心房大小、平均二尖瓣面积及平均二尖瓣压差无显著差异。大量老年患者的二尖瓣评分不适合进行BMV/CMV（I组为7%，II组为38%，III组为80%；p值小于0.001）。