Tyagi Gaurav, Dang Patricia, Pasca Ioana, Patel Reena, Pai Ramdas G
J Heart Valve Dis. 2014 Nov;23(6):707-12.
Degenerative mitral stenosis (DMS) is an increasingly common echocardiographic finding, yet the clinical and biological behavior and rate of progression of the condition are unknown.
A total of 254 patients was identified from the authors' echocardiographic database with DMS, defined as severe mitral annular calcification with extension into the mitral leaflets resulting in transmitral flow acceleration with a mean diastolic gradient of >2 mmHg in the absence of commissural fusion. Each patient required paired echocardiograms to have been recorded at least three months apart. Clinical, biochemical and pharmacological data were collected from each patient and related to the annualized rate of increase in mean diastolic mitral gradient and stenosis severity on a scale of 0 to 3.
The characteristics of the patients were as follows: mean age 71 +/- 15 years; female gender 73%; and left ventricular ejection fraction 66 +/- 13%. Diabetes was present in 50% of patients, renal insufficiency in 40%, and coronary artery disease in 50%. Over a follow up period of 2.6 +/- 2.2 years, the mean gradient was increased by 0.8 +/- 2.4 mmHg (range: 0-15 mmHg) per year, while the stenosis grade was increased by 0.18 +/- 0.5 (range: 0-3) per year. The rate of progression was faster in patients with lesser degrees of stenosis (p = 0.01) and low serum albumen levels (p = 0.04), and slower in those receiving beta-blockers (p = 0.01). Milder stenosis, diabetes mellitus and lack of beta-blocker use were independent predictors of faster DMS progression.
DMS progression is highly variable, but generally slow; its progression is accelerated in the presence of diabetes mellitus, but is retarded by beta-blocker use. DMS may be an active biological process offering potentially modifiable targets for intervention.
退行性二尖瓣狭窄（DMS）是一种越来越常见的超声心动图表现，但该疾病的临床和生物学行为以及进展速度尚不清楚。
从作者的超声心动图数据库中识别出254例患有DMS的患者，DMS定义为严重的二尖瓣环钙化并延伸至二尖瓣叶，导致二尖瓣血流加速，平均舒张期梯度>2 mmHg，且无瓣叶融合。每位患者需要至少间隔三个月记录两次配对的超声心动图。收集每位患者的临床、生化和药理学数据，并将其与平均舒张期二尖瓣梯度的年化增长率以及0至3级的狭窄严重程度相关联。
患者的特征如下：平均年龄71±15岁；女性占73%；左心室射血分数66±13%。50%的患者患有糖尿病，40%的患者有肾功能不全，50%的患者有冠状动脉疾病。在2.6±2.2年的随访期内，平均梯度每年增加0.8±2.4 mmHg（范围：0 - 15 mmHg），而狭窄程度每年增加0.18±0.5（范围：0 - 3）。狭窄程度较轻的患者（p = 0.01）和血清白蛋白水平较低的患者（p = 0.04）进展速度更快，而接受β受体阻滞剂治疗的患者进展较慢（p = 0.01）。轻度狭窄、糖尿病和未使用β受体阻滞剂是DMS进展较快的独立预测因素。
DMS的进展高度可变，但通常较慢；糖尿病会加速其进展，而β受体阻滞剂的使用则会减缓其进展。DMS可能是一个活跃的生物学过程，提供了潜在的可干预靶点。
