Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Am J Cardiol. 2014 Mar 15;113(6):1006-10. doi: 10.1016/j.amjcard.2013.12.009. Epub 2013 Dec 25.
Mitral valve repair for mitral regurgitation (MR) is currently recommended based on the degree of MR and left ventricular (LV) function. The present study examines predictors of reverse remodeling after repair for degenerative disease. We retrospectively identified 439 patients who underwent repair for myxomatous mitral valve degeneration and had both pre- and postoperative echocardiographic data available. Patients were categorized based on left atrial (LA) diameter and LV diameter standards of the American Society of Echocardiography. The outcome of interest was the degree of reverse remodeling on all heart dimensions at follow-up. Mean age was 57 ± 12 years, and 37% of patients were women. Mean preoperative LV end-diastolic diameter was 5.8 ± 0.7 cm, LV end-systolic diameter 3.5 ± 0.6 cm, LA 4.7 ± 0.7 cm, and median ejection fraction 60%. Median observation time was 81 months, and time to postoperative echocardiography was 38 months. Overall, 95% of patients had normal LV diastolic dimensions postoperatively, 93% normal LV systolic dimensions, and 37% normal LA dimensions. A Cox regression analysis showed that moderate (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3 to 3.4) or severe preoperative LA dilatation (OR 2.7, 95% CI 1.7 to 4.4), abnormal preoperative LV end-systolic dimensions (OR 1.3, 95% CI 1.1 to 1.5), and age in years (OR 1.02, 95% CI 1.01 to 1.03) were predictive of less reverse remodeling on follow-up. In conclusion, preoperative LV end-systolic dimensions and LA dilatation substantially affect the likelihood of successful LA remodeling and normalization of all heart dimensions after mitral valve repair for MR. These findings support early operation for MR before the increase in heart dimensions is nonreversible.
对于二尖瓣反流（MR），目前建议根据 MR 程度和左心室（LV）功能进行二尖瓣修复。本研究探讨了退行性疾病修复后逆转重构的预测因素。我们回顾性地确定了 439 名因黏液样二尖瓣变性而行修复的患者，这些患者均具有术前和术后超声心动图数据。根据美国超声心动图学会的左心房（LA）直径和 LV 直径标准对患者进行分类。感兴趣的结局是在随访时所有心脏维度的逆转重构程度。平均年龄为 57 ± 12 岁，37%的患者为女性。平均术前 LV 舒张末期直径为 5.8 ± 0.7cm，LV 收缩末期直径为 3.5 ± 0.6cm，LA 为 4.7 ± 0.7cm，中位数射血分数为 60%。中位观察时间为 81 个月，术后超声心动图时间为 38 个月。总体而言，95%的患者术后 LV 舒张末期直径正常，93%的患者 LV 收缩末期直径正常，37%的患者 LA 直径正常。Cox 回归分析显示，中度（比值比[OR] 2.1，95%置信区间[CI] 1.3 至 3.4）或重度术前 LA 扩张（OR 2.7，95%CI 1.7 至 4.4）、异常术前 LV 收缩末期尺寸（OR 1.3，95%CI 1.1 至 1.5）和年龄（OR 1.02，95%CI 1.01 至 1.03）与随访时逆转重构减少相关。总之，术前 LV 收缩末期尺寸和 LA 扩张极大地影响了二尖瓣修复后 LA 重构和所有心脏尺寸正常化的可能性。这些发现支持在心脏尺寸增加不可逆转之前，尽早对 MR 进行手术。
