Department of Cardiology, University Hospital of Marseille, Marseille, France.
Eur Heart J. 2013 Sep;34(33):2600-9. doi: 10.1093/eurheartj/eht250. Epub 2013 Jul 12.
Define the impact of age at diagnosis on degenerative mitral regurgitation (MR) prognosis.
The Mitral regurgitation International DAtabase (MIDA) is a multicentre registry of MR due to flail leaflets including 862 patients (65 ± 12 years) diagnosed by echocardiography. The 498 older patients (≥65 years at diagnosis) were compared with the 364 younger (<65) with regard to presentation and the outcome was compared with that expected in the general population. Older vs. younger patients had MR of similar severity and ventricular overload but presented with more MR consequences and incurred higher mortality [risk ratio (rr) 95% confidence interval (95% CI) 4.7 (2.5-10.0), P < 0.001] independently of co-morbidity. Compared with expected survival [relative risk (95% confidence interval)], excess mortality, non-significant in younger patients [1.1 (0.6-2.0), P = 0.65], was prominent in older patients [1.4 (1.2-1.7), P < 0.001]. Compared with expected, excess heart failure (HF) occurred in younger [9.3 (6.5-13.3), P < 0.0001) and in older patients [6.7 (5.6-8.1), P < 0.0001]. Excess atrial fibrillation (AF) was even higher in younger [6.9 (4.5-10.6), P < 0.0001] than in older patients [3.5 (2.6-4.7), P < 0.0001; P < 0.001 for comparison between age groups]. Subsequent excess mortality [rr (95% CI)] was associated with occurrence of HF and/or AF in both age groups [13.5 (7.4-24.6), P < 0.001]. Mitral surgery was associated with reduced long-term mortality in older patients and lower rate of HF in both the age groups (all P < 0.01).
Both older and younger patients incurred excess risk of complications. Older patients suffered excess mortality, AF, and HF, whereas younger incurred excess morbidity linked to subsequent long-term excess mortality. The excess risks of uncorrected degenerative MR should be considered in deliberating surgical management, which significantly reduced mortality in older patients and HF in younger patients.
定义诊断时年龄对退行性二尖瓣反流（MR）预后的影响。
二尖瓣反流国际数据库（MIDA）是一个多中心注册中心，包括 862 例因连枷状瓣叶导致的 MR 患者（65±12 岁），通过超声心动图诊断。将 498 例年龄较大（诊断时≥65 岁）的患者与 364 例年龄较小（＜65 岁）的患者进行比较，比较了他们的表现，并将结果与一般人群的预期结果进行了比较。年龄较大的患者与年龄较小的患者具有相似严重程度和心室负荷过重的 MR，但表现出更多的 MR 后果，并导致更高的死亡率[风险比（95%置信区间）4.7（2.5-10.0），P＜0.001]，与合并症无关。与预期的生存率[相对风险（95%置信区间）]相比，年龄较大的患者[1.4（1.2-1.7），P＜0.001]的超额死亡率不显著，而年龄较小的患者[1.1（0.6-2.0），P=0.65]的超额死亡率显著。与预期相比，心力衰竭（HF）在年龄较小的患者中发生[9.3（6.5-13.3），P＜0.0001）和年龄较大的患者中发生[6.7（5.6-8.1），P＜0.0001）。年龄较小的患者中，心房颤动（AF）的发生率甚至更高[6.9（4.5-10.6），P＜0.0001]，而年龄较大的患者[3.5（2.6-4.7），P＜0.0001）；两组之间的比较[P＜0.001]。随后的超额死亡率[RR（95%CI）]与两组中 HF 和/或 AF 的发生相关[13.5（7.4-24.6），P＜0.001]。二尖瓣手术与老年患者的长期死亡率降低和两组患者 HF 发生率降低相关（均 P＜0.01）。
年龄较大和较小的患者都有发生并发症的风险。老年患者发生死亡、AF 和 HF 的风险更高，而年轻患者则发生与随后长期死亡率相关的发病率更高。退行性二尖瓣 MR 未经矫正的风险应在考虑手术治疗时加以考虑，这可显著降低老年患者的死亡率和年轻患者的 HF 发生率。
