Division of Noninvasive Cardiology, San Raffaele Hospital, Scientific Institute, Milan, Italy.
J Am Soc Echocardiogr. 2011 Dec;24(12):1376-82. doi: 10.1016/j.echo.2011.09.006. Epub 2011 Oct 20.
Although the prognostic impact of a moderate degree of ischemic mitral regurgitation (IMR) is well known, there are no data regarding the potential role of a mild degree of IMR. The aim of this study was to evaluate the impact of a mild degree (effective regurgitant orifice area < 20 mm(2)) of IMR on left ventricular (LV) remodeling and heart failure (HF).
A retrospective study was conducted in 35 patients with mild IMR that were propensity matched with 35 patients without IMR (controls). The population was evaluated between 3 and 6 months after first myocardial infarction and at 6 and 12 months, measuring LV volumes, ejection fraction, and the degree of mitral regurgitation. HF events requiring hospitalization were recorded.
The two groups were similar at baseline. During follow-up, patients with IMR showed significant increases in LV end-diastolic and end-systolic volumes and no change in ejection fractions, whereas controls did not show significant changes in volumes but did show increases in ejection fractions. Patients with IMR showed significantly higher end-systolic volumes at 6 months (P = .003) and 12 months (P = .007) and significantly higher end-diastolic volumes at 6 months (P = .048) and 12 months (P = .03) and lower ejection fractions at 6 months (P = .0001) and 12 months (P = .002) compared with controls. Patients with IMR experienced a significantly higher incidence of HF than controls (62% vs 23%, P = .001). At 6 months, in six patients mitral regurgitation degree changed from mild to moderate, and in one patient from mild to severe. Interestingly, 71.5% of patients who experienced increases in mitral regurgitation degree had no coronary revascularization (P = .04).
Mild IMR affects the LV remodeling process, increases its degree over time, and determines a higher rate of HF.
尽管中度缺血性二尖瓣反流（IMR）的预后影响已广为人知，但对于轻度 IMR 的潜在作用尚无数据。本研究旨在评估轻度 IMR（有效反流口面积＜20mm²）对左心室（LV）重构和心力衰竭（HF）的影响。
对 35 例轻度 IMR 患者进行回顾性研究，并与 35 例无 IMR 患者（对照组）进行倾向评分匹配。该人群在首次心肌梗死后 3 至 6 个月以及 6 至 12 个月进行评估，测量 LV 容积、射血分数和二尖瓣反流程度。记录需要住院治疗的 HF 事件。
两组在基线时相似。在随访期间，有 IMR 的患者 LV 舒张末期和收缩末期容积显著增加，射血分数无变化，而对照组的容积无显著变化，但射血分数增加。有 IMR 的患者在 6 个月（P=0.003）和 12 个月（P=0.007）时的收缩末期容积显著升高，在 6 个月（P=0.048）和 12 个月（P=0.03）时的舒张末期容积显著升高，而射血分数在 6 个月（P=0.0001）和 12 个月（P=0.002）时显著降低，与对照组相比。有 IMR 的患者发生 HF 的发生率显著高于对照组（62% vs 23%，P=0.001）。在 6 个月时，有 6 例患者的二尖瓣反流程度从轻度变为中度，有 1 例从轻度变为重度。有趣的是，71.5%的二尖瓣反流程度增加的患者没有进行冠状动脉血运重建（P=0.04）。
轻度 IMR 影响 LV 重构过程，随着时间的推移其程度增加，并导致 HF 发生率增加。
