Cardiologia, ARC, Azienda Ospedaliera S. Maria degli Angeli, Via Montereale, 24, 33170 Pordenone, Italy.
Circulation. 2010 May 18;121(19):2130-6. doi: 10.1161/CIRCULATIONAHA.109.891598. Epub 2010 May 3.
At present, no medical therapy is known to affect the progression of rheumatic mitral stenosis (MS). We sought to assess the effect of statin treatment on long-term progression of MS in a large population.
From our 20-year database, we identified all patients with rheumatic MS with > or =2 echocardiographies > or =1 year apart. Exclusion criteria were previous intervention on the mitral valve, more than moderate aortic regurgitation, or symptoms at first examination. The study sample included 315 patients (mean age, 61+/-12 years; 224 women); 35 patients (11.1%) were treated with statins, and 280 (88.9%) were not. Mean follow-up period was 6.1+/-4.0 years (range, 1 to 20). The rate of decrease in mitral valve area was significantly lower in the statin group compared with the untreated group (0.027+/-0.056 versus 0.067+/-0.082 cm(2)/y; P=0.005). The annualized change in mean transmitral gradient was lower in statin-treated patients (0.20+/-0.59 versus 0.58+/-0.96 mm Hg/y; P=0.023). The prevalence of fast MS progression (annual change in mitral valve area >0.08 cm(2)) was significantly lower in the statin group (P=0.008). An increase in systolic pulmonary artery pressure of >10 mm Hg was found in 17% of patients in the statin group versus 40% of untreated patients (P=0.045).
Our study shows a significantly slower progression of rheumatic MS in patients treated with statins. These findings could have an important impact in the early medical therapy of patients with rheumatic heart disease.
目前，尚无医学疗法被证实可影响风湿性二尖瓣狭窄（MS）的进展。我们旨在评估他汀类药物治疗对大量人群中 MS 长期进展的影响。
我们从 20 年的数据库中，确定了所有具有 >或=2 次超声心动图检查且两次检查间隔>或=1 年的风湿性 MS 患者。排除标准为先前对二尖瓣的干预、中重度主动脉瓣反流或初次检查时出现症状。研究样本包括 315 例患者（平均年龄 61+/-12 岁；224 例女性）；35 例（11.1%）接受了他汀类药物治疗，280 例（88.9%）未接受治疗。平均随访时间为 6.1+/-4.0 年（范围 1 至 20 年）。与未治疗组相比，他汀组的二尖瓣瓣口面积减小率明显更低（0.027+/-0.056 比 0.067+/-0.082 cm(2)/y；P=0.005）。他汀类药物治疗患者的平均跨瓣梯度的年变化率较低（0.20+/-0.59 比 0.58+/-0.96 mm Hg/y；P=0.023）。他汀组快速 MS 进展（每年二尖瓣瓣口面积变化>0.08 cm(2)）的发生率明显更低（P=0.008）。在他汀组中发现 17%的患者收缩期肺动脉压升高>10 mm Hg，而未治疗组中这一比例为 40%（P=0.045）。
我们的研究表明，接受他汀类药物治疗的患者风湿性 MS 的进展明显较慢。这些发现可能对风湿性心脏病患者的早期药物治疗具有重要影响。
