Epidemiology Section, School of Public Health, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Int J Cardiol. 2010 Aug 20;143(2):113-8. doi: 10.1016/j.ijcard.2010.02.011. Epub 2010 Mar 7.
The underlying causes of chordae tendinae rupture (CTR) and their frequencies vary. Different publications reached conflicting conclusions due to diverse definitions, different detection measures, and morbidity trends over time.
Systematic literature review of unselected CTR series and underlying cause frequencies reanalysis.
Primary CTR overall rates before and since 1985 remain considerable (52.5% vs. 51.2%), yet median decreased (35% and 14%). Sub-acute endocarditis (SBE) and rheumatic heart disease (RHD) were the most frequent causes before 1985 (54.4% and 42.1%, respectively); since 1985 SBE and RHD have dropped sharply to 37.4% and 24.8%, respectively. Since 1985, mitral valve prolapse (MVP) and myxomatous degeneration (MD) have caused 44.5% and 11.7%, respectively. All other causes were almost not evident.
"Primary CTR" remains significant. MD may be underestimated, as microscopic evaluation was not routinely performed. MD is probably the most frequent underlying cause given it is also the underlying cause of MVP. MVP may be overestimated due to detection criteria and misinterpretation of leaflet prolapse. SBE, frequently coexistent with other underlying causes, may be overestimated either due to detection bias or being a consequence rather than CTR cause. RHD is expected to further decline, following rheumatic fever. Previous significant underlying causes proved to be episodic if at all causative, e.g., blunt chest trauma, generalized connective tissue disorder, ischemic heart disease, and other heart and valvular diseases. CTR can occur in apparently healthy subjects having no atypical appearance and who may be unaware of carrying risk.
腱索断裂（CTR）的根本原因及其发生频率各不相同。由于定义不同、检测方法不同以及发病率随时间的变化趋势不同，不同的出版物得出了相互矛盾的结论。
对未经选择的 CTR 系列和潜在病因频率进行系统的文献回顾和重新分析。
1985 年以前和以后的原发性 CTR 总发生率仍然相当高（分别为 52.5%和 51.2%），但中位数有所下降（分别为 35%和 14%）。亚急性心内膜炎（SBE）和风湿性心脏病（RHD）是 1985 年以前最常见的病因（分别为 54.4%和 42.1%）；自 1985 年以来，SBE 和 RHD 急剧下降至 37.4%和 24.8%。自 1985 年以来，二尖瓣脱垂（MVP）和黏液样变性（MD）分别导致了 44.5%和 11.7%的病例。其他所有病因几乎都不明显。
“原发性 CTR”仍然很重要。由于未常规进行显微镜评估，MD 可能被低估。鉴于 MD 也是 MVP 的潜在病因，它可能是最常见的潜在病因。由于检测标准和对瓣叶脱垂的误解，MVP 可能被高估。由于检测偏差或 SBE 是其他潜在病因的结果而非 CTR 的病因，SBE 可能被高估。随着风湿热的流行，RHD 预计会进一步下降。以前的重要潜在病因，如果有任何因果关系，证明是偶发性的，例如钝性胸部创伤、广泛结缔组织疾病、缺血性心脏病和其他心脏和瓣膜疾病。CTR 可发生在无明显异常且无任何风险意识的看似健康的患者中。
