Cardiology Department, AP-HP, Bichat Hospital, Paris, France.
Circulation. 2012 May 1;125(17):2119-27. doi: 10.1161/CIRCULATIONAHA.111.055905. Epub 2012 Mar 28.
Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified.
Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm(2) without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2 ± 2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification (P<0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation (P<0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort.
Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
经皮二尖瓣交界分离术的长期随访使我们能够确定晚期结果的预测因素。
对 1024 例连续患者进行了经皮二尖瓣交界分离术的晚期结果评估。912 例患者（89%）获得了良好的即时结果，定义为瓣口面积≥1.5cm²，无 2/4 以上的二尖瓣反流。这 912 例患者被随机分为两组，分别为 609 例和 303 例患者，分别用于开发和验证预测晚期功能结果的评分系统。20 年时的良好功能结果（无心血管死亡、二尖瓣手术或再次经皮二尖瓣交界分离术，且纽约心脏协会心功能分级 I 或 II 级）率为 30.2%±2.0%。多变量 Cox 模型确定了 7 个预测晚期功能结果不良的因素：较高的最终平均梯度（P<0.0001）、年龄与最终二尖瓣瓣口面积的相互作用（P<0.0001）表明瓣口面积的影响随年龄而降低、性别与瓣叶钙化的相互作用（P<0.0001）表明瓣叶解剖结构的影响在男性中更强，以及节律与纽约心脏协会心功能分级的相互作用表明只有在心房颤动患者中，纽约心脏协会心功能分级才有影响（P<0.0001）。一个 13 分的评分系统能够将患者分为 3 个风险组，在验证队列中，预测 20 年时的良好功能结果分别为 55.1%、29.1%和 10.5%。
在具有不同特征的患者人群中，经皮二尖瓣交界分离术后 20 年，仍有 30%的患者功能良好。晚期功能结果的预测是多因素的，并且主要取决于年龄和即时结果的质量。一个简单的验证评分系统可用于评估个体患者的预后。
