Lancellotti Patrizio, Magne Julien, Dulgheru Raluca, Ancion Arnaud, Martinez Christophe, Piérard Luc A
Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium; GVM Care and Research, E.S. Health Science Foundation, Lugo (RA), Italy.
Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
Am J Cardiol. 2015 May 15;115(10):1454-61. doi: 10.1016/j.amjcard.2015.02.028. Epub 2015 Feb 18.
In patients with heart failure, exercise echocardiography can help in risk stratification and decision making. The prognostic significance of exercise pulmonary hypertension (PH) in patients with secondary mitral regurgitation (MR) remains unknown. The aim of the present study was to assess the prognostic value of exercise PH in patients with secondary MR and narrow QRS intervals. From 2005 to 2012, 159 consecutive patients with secondary MR, narrow QRS intervals, left ventricular dysfunction (mean ejection fraction 36 ± 7%), and measurable systolic pulmonary arterial pressure (SPAP) during exercise echocardiography were included. Resting and exercise PH were defined as SPAP >50 and >60 mm Hg, respectively. Exercise PH was more frequent than resting PH (40% vs 13%, p <0.0001). On multivariate logistic regression, the independent determinants of exercise PH were resting SPAP (p <0.0001), exercise MR severity (p <0.0001), and e'-wave velocity (p = 0.004). The incidence of cardiac events during follow-up was significantly higher in patients with exercise PH compared with those without exercise PH (4 years: 40 ± 7% vs 20 ± 5%, p <0.0001). Patients with exercise PH exhibited higher rates of cardiac events and death than those with resting PH. In a multivariate Cox proportional hazards model, exercise PH was independently associated with the occurrence of cardiac events (p <0.0001). In conclusion, in patients with secondary MR, exercise PH is determined mainly by resting SPAP, left ventricular diastolic burden, and exercise MR severity. Exercise PH is a powerful predictor of poor outcomes, with a 5.3-fold increased risk for cardiac-related death during follow-up. These results highlight the added value of exercise echocardiography in secondary MR.
在心力衰竭患者中，运动超声心动图有助于进行风险分层和决策。运动性肺动脉高压（PH）在继发性二尖瓣反流（MR）患者中的预后意义尚不清楚。本研究的目的是评估运动性PH在继发性MR且QRS间期狭窄患者中的预后价值。2005年至2012年，纳入了159例连续性继发性MR、QRS间期狭窄、左心室功能障碍（平均射血分数36±7%）且在运动超声心动图检查期间可测量收缩期肺动脉压（SPAP）的患者。静息和运动性PH分别定义为SPAP>50和>60 mmHg。运动性PH比静息性PH更常见（40%对13%，p<0.0001）。在多因素logistic回归分析中，运动性PH的独立决定因素是静息SPAP（p<0.0001）、运动性MR严重程度（p<0.0001）和e'波速度（p=0.004）。与无运动性PH的患者相比，运动性PH患者随访期间心脏事件的发生率显著更高（4年：40±7%对20±5%，p<0.0001）。运动性PH患者的心脏事件和死亡率高于静息性PH患者。在多因素Cox比例风险模型中，运动性PH与心脏事件的发生独立相关（p<0.0001）。总之，在继发性MR患者中，运动性PH主要由静息SPAP、左心室舒张负荷和运动性MR严重程度决定。运动性PH是不良预后的有力预测指标，随访期间心脏相关死亡风险增加5.3倍。这些结果突出了运动超声心动图在继发性MR中的附加价值。
