Department of Cardiology and Endocrinology, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Eur J Heart Fail. 2011 Oct;13(10):1121-5. doi: 10.1093/eurjhf/hfr114. Epub 2011 Aug 23.
To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients.
We studied a large group of patients hospitalized for symptoms and clinical signs of HF in the period 2001-02. Mitral regurgitation was diagnosed on echocardiography and qualitatively graded as no/trace, mild, moderate, and severe using the colour Doppler method. Median follow-up time was 4.5 years. Three thousand and seventy-eight patients with HF were included, of whom 1890 patients (61%) had no/trace MR, 628 (20%) had mild MR, 452 (15%) had moderate MR, and 108 (4%) had severe MR. During follow-up, 1660 deaths (54%) were registered. In univariate analysis, increasing severity of MR carried an increasing mortality risk, hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.04-1.16, P = 0.0006 for each increasing degree of MR. In multivariable analysis, with adjustments made for age, sex, ejection fraction, serum creatinine, presence of ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and stroke, similar results were found, but only in patients with LVEF<25%, HR 1.14, 95% CI 1.03-1.26, P = 0.01 for each increasing degree of MR. This risk was driven by moderate and severe MR. For patients with LVEF≥25% the HR was 0.91, 95% CI 0.82-1.03, P = 0.2 for each increasing degree of MR.
Mitral regurgitation has a negative effect on prognosis of patients with HF, but only in patients with severely reduced LVEF.
研究二尖瓣反流（MR）与左心室射血分数（LVEF）在心力衰竭（HF）患者死亡风险中的相互作用。
我们研究了一组 2001-02 年因 HF 症状和临床体征住院的患者。通过超声心动图诊断二尖瓣反流，并使用彩色多普勒法定性分为无/微量、轻度、中度和重度。中位随访时间为 4.5 年。共纳入 3078 例 HF 患者，其中 1890 例（61%）无/微量 MR，628 例（20%）轻度 MR，452 例（15%）中度 MR，108 例（4%）重度 MR。随访期间，共登记 1660 例死亡（54%）。单因素分析显示，MR 严重程度增加与死亡风险增加相关，危险比（HR）为 1.10，95%置信区间（CI）为 1.04-1.16，P = 0.0006，MR 每增加一级。多变量分析调整年龄、性别、射血分数、血清肌酐、是否存在缺血性心脏病、慢性阻塞性肺疾病、糖尿病和中风后，发现类似结果，但仅在 LVEF<25%的患者中，HR 为 1.14，95%CI 为 1.03-1.26，P = 0.01，MR 每增加一级。这种风险是由中度和重度 MR 驱动的。对于 LVEF≥25%的患者，HR 为 0.91，95%CI 0.82-1.03，P = 0.2，MR 每增加一级。
二尖瓣反流对射血分数严重降低的 HF 患者的预后有负面影响。
