Mahfouz Ragab A, Dewedar Ashraf, Elzayat Ahmad, Elawady Waleed
Department of Cardiology, Faculty of Medicine, Zagazig Univeristy Hospital, Egypt.
Cardiol J. 2014;21(2):152-7. doi: 10.5603/CJ.a2013.0086. Epub 2013 Jun 25.
We aimed to create a novel modified score by combining anatomic and hemodynamic Doppler-echocardiographic measures for selection of suitable patients with mitral stenosis for percutaneous balloon mitral valvuloplasty (PBMV) and its impact in prediction of outcome.
262 consecutive patients candidate for PBMV were enrolled. Wilkins score and a global score based on anatomical parameters (Wilkins score, posterior to anterior mitral leaflet ratio [PMVL/AMVL ratio]; left atrial diameter [LAD]) and hemodynamic parameters (mitral regurgitation [MR]; atrioventricular compliance [CN]; systolic pulmonary artery pressure [SPAP]) were assessed. Patients were classified into two groups according to their outcomes.
Global Echo-Doppler Score (GEDS) for patients with favorable vs. those with unfavorable outcomes was (5.0 ± 0.9 vs. 8.9 ± 1.3; p < 0.001). Sensitivity, specificity, and accuracy of a GEDS ≥ 7 for prediction of cardiac events were 97.5%, 88%, and 97.5%, respectively. The area under the receiver operating characteristic curve was 0.95 (p < 0.001). The correlation coefficient was 0.852 (p < 0.0001) for GEDS 0.531 (p < 0.002), for Wilkins score 0.315 (p < 0.02), for PMVL/AMVL 0.460 (p < 0.01), for LAD; MR: Pre-PBMV (r = 0.348, p < 0.03); CN [mL/mm Hg] (r = 0.579, p < 0.01) and SPAP [mm Hg] (r = 0.499, p < 0.01). In the regression analysis, GEDS, Wilkins score, and LAD were entered into the model. The regression coefficient (r = 0.695) of GEDS was much higher than those of the other 2 factors.
GEDS is an independent predictor of PBMV success and clinical outcome and may be formulated in a scoring system that would help to identify the proper timing and best candidates for PBMV.
我们旨在通过结合解剖学和血流动力学多普勒超声心动图测量方法创建一种新的改良评分，以筛选适合经皮二尖瓣球囊成形术（PBMV）的二尖瓣狭窄患者，并评估其对预后预测的影响。
连续纳入262例拟行PBMV的患者。评估威尔金斯评分以及基于解剖学参数（威尔金斯评分、二尖瓣后叶与前叶比值[PMVL/AMVL比值]；左心房直径[LAD]）和血流动力学参数（二尖瓣反流[MR]；房室顺应性[CN]；收缩期肺动脉压[SPAP]）的综合评分。根据患者的预后将其分为两组。
预后良好与预后不良患者的综合超声多普勒评分（GEDS）分别为（5.0±0.9对8.9±1.3；p<0.001）。GEDS≥7预测心脏事件的敏感性、特异性和准确性分别为97.5%、88%和97.5%。受试者工作特征曲线下面积为0.95（p<0.001）。GEDS的相关系数为0.852（p<0.0001），威尔金斯评分为0.531（p<0.002），PMVL/AMVL为0.315（p<0.02），LAD为0.460（p<0.01）；MR：PBMV前（r=0.348，p<0.03）；CN[mL/mm Hg]（r=0.579，p<0.01）和SPAP[mm Hg]（r=0.499，p<0.01）。在回归分析中，将GEDS、威尔金斯评分和LAD纳入模型。GEDS的回归系数（r=0.695）远高于其他两个因素。
GEDS是PBMV成功及临床预后的独立预测指标，可纳入评分系统，有助于确定PBMV的合适时机和最佳候选者。
