Yingchoncharoen Teerapat, Negishi Tomoko, Stanton Tony, Marwick Thomas H
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Am Soc Echocardiogr. 2014 Jun;27(6):608-15. doi: 10.1016/j.echo.2014.02.009. Epub 2014 Mar 26.
Increased left ventricular (LV) dimensions are an indication for surgery in patients with asymptomatic mitral regurgitation, but M-mode or two-dimensional measurements have known limitations. The aim of this study was to determine the value of three-dimensional echocardiography in predicting postoperative outcomes after mitral surgery.
Sixty-seven patients with severe asymptomatic or minimally symptomatic mitral regurgitation (69% men; mean age, 62 ± 13 years) who underwent mitral valve surgery from January 2010 to December 2011 were studied. In addition to standard echocardiography, baseline three-dimensional echocardiography was performed for accurate quantification of LV size. Patients were followed over a median time of 1 month (interquartile range, 0-8 months) for postoperative development of atrial fibrillation or LV dysfunction. A multivariate regression analysis was performed to identify associations with events.
Postoperative LV dysfunction developed in 15 patients (22%), and 21 patients (31%) had postoperative atrial fibrillation. There was no association between two-dimensional end-systolic volume index and outcomes (hazard ratio, 1.02; P = .18). Postoperative atrial fibrillation or LV dysfunction was associated with baseline three-dimensional LV end-systolic volume index (hazard ratio, 1.06; 95% confidence interval, 1.04-1.16), independent of age and presence of coronary artery disease. LVESVi ≥ 40 mL/m(2) was the best cutoff value to predict postoperative events (sensitivity, 80%; specificity, 85%). After adding LVESVi to a model containing clinical and echocardiographic parameters, net reclassification improvement was 0.27 (95% confidence interval, 0.25-0.29; P = .024).
LVESVi from three-dimensional echocardiography is an independent predictor of postoperative outcomes in patients with severe mitral regurgitation that is incremental to other clinical and echocardiographic variables.
左心室（LV）尺寸增加是无症状二尖瓣反流患者手术的指征，但M型或二维测量存在已知局限性。本研究的目的是确定三维超声心动图在预测二尖瓣手术后预后的价值。
对2010年1月至2011年12月接受二尖瓣手术的67例严重无症状或轻度症状性二尖瓣反流患者（69%为男性；平均年龄62±13岁）进行研究。除标准超声心动图外，还进行了基线三维超声心动图检查以准确量化左心室大小。对患者进行了中位时间为1个月（四分位间距，0 - 8个月）的随访，观察术后房颤或左心室功能障碍的发生情况。进行多变量回归分析以确定与事件的关联。
15例患者（22%）发生术后左心室功能障碍，21例患者（31%）发生术后房颤。二维收缩末期容积指数与预后无关联（风险比，1.02；P = 0.18）。术后房颤或左心室功能障碍与基线三维左心室收缩末期容积指数相关（风险比，1.06；95%置信区间，1.04 - 1.16），独立于年龄和冠状动脉疾病的存在。左心室收缩末期容积指数≥40 mL/m²是预测术后事件的最佳临界值（敏感性，80%；特异性，85%）。将左心室收缩末期容积指数添加到包含临床和超声心动图参数的模型后，净重新分类改善为0.27（95%置信区间，0.25 - 0.29；P = 0.024）。
三维超声心动图测得的左心室收缩末期容积指数是严重二尖瓣反流患者术后预后的独立预测指标，相对于其他临床和超声心动图变量具有增量价值。
