Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
Eur J Cardiothorac Surg. 2012 Mar;41(3):506-11. doi: 10.1093/ejcts/ezr004. Epub 2011 Oct 18.
Restrictive mitral annuloplasty (RMA) can often improve heart failure symptoms and induce left ventricular (LV) reverse remodelling in patients with non-ischaemic dilated cardiomyopathy (DCM) and functional mitral regurgitation. However, it is unknown whether the observed LV reverse remodelling translates into better outcomes or not.
Fifty patients with advanced non-ischaemic DCM (age, 64 ± 10 years, 74% men) underwent RMA and were followed up with a mean of 2 years. Preoperatively, all had 3 to 4+ functional mitral regurgitation (MR), an ejection fraction (EF) of 26 ± 8.6 %, an indexed LV end-systolic volume (LVESVI) of 112 ± 47 ml/m(2). All patients received complete semi-rigid undersized ring annuloplasty. Correlations between early reduction in LVESVI at 1 month after the operation and mid-term clinical outcomes were analysed.
There was no 30-day mortality. LVESVI significantly decreased to 96 ± 53 ml/m(2) and LVEF improved to 31 ± 15%. During follow-up, 16 (32%) recurred heart failure, of whom 7 (14%) died. The receiver operating characteristic (ROC) curve found that a reduction in LVESVI >8.3% had a sensitivity of 80% and a specificity of 78% in predicting all adverse events. With this cut-off value, there were 30 (60%) responders to reverse remodelling. Responders had significantly better survival (96.4 versus 68.7%, P = 0.007) and freedom from heart failure rate (85.4 versus 31.8%, P = 0.0003) than non-responders at 3 years. In a 1-year follow-up echocardiographic study, non-responders had shown no significant LV reverse remodelling with greater degree of residual MR than responders.
The extent of early LV reverse remodelling is related to mid-term mortality, heart failure events and late reverse remodelling and repair durability after RMA for non-ischaemic DCM.
限制型二尖瓣成形术（RMA）可改善非缺血性扩张型心肌病（DCM）伴功能性二尖瓣反流患者的心力衰竭症状并诱导左心室（LV）逆重构。然而，目前尚不清楚观察到的 LV 逆重构是否会转化为更好的结果。
50 例晚期非缺血性 DCM 患者（年龄 64±10 岁，男性占 74%）接受 RMA 治疗并随访平均 2 年。所有患者术前均有 3 至 4+级功能性二尖瓣反流（MR）、射血分数（EF）为 26±8.6%、左心室收缩末期容积指数（LVESVI）为 112±47ml/m²。所有患者均接受完整的半刚性小环成形术。分析术后 1 个月时 LVESVI 早期降低与中期临床结果之间的相关性。
无 30 天死亡率。LVESVI 显著下降至 96±53ml/m²，LVEF 提高至 31±15%。随访期间，16 例（32%）心力衰竭复发，其中 7 例（14%）死亡。受试者工作特征（ROC）曲线发现，LVESVI 降低>8.3%预测所有不良事件的敏感性为 80%，特异性为 78%。根据此截断值，有 30 例（60%）患者对逆重构有反应。与无反应者相比，有反应者的生存率显著提高（96.4%比 68.7%，P=0.007），心力衰竭发生率降低（85.4%比 31.8%，P=0.0003），3 年时差异有统计学意义。在 1 年的超声心动图随访研究中，无反应者无明显 LV 逆重构，且残余 MR 程度大于有反应者。
非缺血性 DCM 患者 RMA 后早期 LV 逆重构程度与中期死亡率、心力衰竭事件及晚期逆重构和修复耐久性相关。
