Jorge Elisabete, Baptista Rui, Faria Henrique, Calisto João, Matos Vítor, Gonçalves Lino, Monteiro Pedro, Providência Luís A
Cardiology Department, Coimbra Hospital and Medical School, Coimbra, Portugal.
Rev Port Cardiol. 2012 Jan;31(1):19-25. doi: 10.1016/j.repc.2011.09.018. Epub 2011 Dec 3.
Percutaneous mitral valvuloplasty (PMV) is an effective treatment option for mitral stenosis (MS), but its success is assessed on the basis of clinical and echocardiographic outcomes in studies with relatively short follow-up. We aimed to characterize a cohort of patients undergoing PMV with long-term follow-up and to determine independent predictors of post-PMV mitral re-intervention and event-free survival.
We studied 91 consecutive patients with MS who underwent PMV with a median clinical follow-up duration of 99 months. Two endpoints were considered: post-PMV mitral re-intervention (PMV or mitral surgery) and a composite clinical events endpoint including cardiovascular death, mitral valve re-intervention and hospital admission due to decompensated heart failure. We compared patients who required post-PMV mitral re-intervention with those who did not during follow-up.
The study population included 83.5% females and mean age was 48.9±13.9 years. The 1-, 3-, 5-, 7- and 9-year rates of clinical event-free survival were 93.0±2.8%, 86.0±3.9%, 81.0±4.4%, 70.6±5.6%, and 68.4±5.8%, respectively. The 1-, 3-, 5-, 7- and 9-year rates of mitral re-intervention-free survival were 98.8±1.2%, 97.5±1.7%, 92.1±3.1%, 85.5±4.5%, and 85.5±4.5%, respectively. The median time to mitral re-intervention was 6.2 years. Patients who required mitral re-intervention during follow-up were younger (43.3 vs. 51.2 years, p=0.04) and had higher pre- and post-PMV mitral gradient (14.9 vs. 11.5 mmHg, p=0.02 and 6.4 vs. 2.1 mmHg, p<0.001) and higher post-PMV mean pulmonary artery pressure (mPAP) (30.0 vs. 23.2 mmHg, p=0.01). In a Cox proportional hazards model, mPAP ≥25 mmHg was the sole predictor of both mitral re-intervention (HR 5.639 [1.246-25.528], p=0.025) and clinical events (HR 3.622 [1.070-12.260], p=0.039).
In our population, immediate post-PMV mPAP was the sole predictor of post-PMV mitral intervention. These findings may help identify patients in need of closer post-PMV follow-up.
经皮二尖瓣球囊成形术（PMV）是二尖瓣狭窄（MS）的一种有效治疗选择，但在随访时间相对较短的研究中，其成功率是根据临床和超声心动图结果来评估的。我们旨在对一组接受PMV并进行长期随访的患者进行特征描述，并确定PMV术后二尖瓣再次干预和无事件生存的独立预测因素。
我们研究了91例连续接受PMV的MS患者，临床随访时间中位数为99个月。考虑了两个终点：PMV术后二尖瓣再次干预（PMV或二尖瓣手术）以及包括心血管死亡、二尖瓣再次干预和因失代偿性心力衰竭住院的综合临床事件终点。我们比较了随访期间需要PMV术后二尖瓣再次干预的患者和未需要再次干预的患者。
研究人群中83.5%为女性，平均年龄为48.9±13.9岁。1年、3年、5年、7年和9年的无临床事件生存率分别为93.0±2.8%、86.0±3.9%、81.0±4.4%、70.6±5.6%和68.4±5.8%。1年、3年、5年、7年和9年的无二尖瓣再次干预生存率分别为98.8±1.2%、97.5±1.7%、92.1±3.1%、85.5±4.5%和85.5±4.5%。二尖瓣再次干预的中位时间为6.2年。随访期间需要二尖瓣再次干预的患者更年轻（43.3岁对51.2岁，p = 0.04），PMV术前和术后二尖瓣压差更高（14.9 mmHg对11.5 mmHg，p = 0.02；6.4 mmHg对2.1 mmHg，p < 0.001），PMV术后平均肺动脉压（mPAP）更高（30.0 mmHg对23.2 mmHg，p = 0.01）。在Cox比例风险模型中，mPAP≥25 mmHg是二尖瓣再次干预（HR 5.639 [1.246 - 25.528]，p = 0.025）和临床事件（HR 3.622 [1.070 - 12.260]，p = 0.039）的唯一预测因素。
在我们的研究人群中，PMV术后即刻mPAP是PMV术后二尖瓣干预的唯一预测因素。这些发现可能有助于识别需要在PMV术后进行更密切随访的患者。
