Pasca Ioana, Dang Patricia, Tyagi Gaurav, Pai Ramdas G
Division of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California.
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California.
J Am Soc Echocardiogr. 2016 May;29(5):461-9. doi: 10.1016/j.echo.2015.12.012. Epub 2016 Feb 28.
Severe mitral annular calcification causing degenerative mitral stenosis (DMS) is increasingly encountered in patients undergoing mitral and aortic valve interventions. However, its clinical profile and natural history and the factors affecting survival remain poorly characterized. The goal of this study was to characterize the factors affecting survival in patients with DMS.
An institutional echocardiographic database was searched for patients with DMS, defined as severe mitral annular calcification without commissural fusion and a mean transmitral diastolic gradient of ≥2 mm Hg. This resulted in a cohort of 1,004 patients. Survival was analyzed as a function of clinical, pharmacologic, and echocardiographic variables.
The patient characteristics were as follows: mean age, 73 ± 14 years; 73% women; coronary artery disease in 49%; and diabetes mellitus in 50%. The 1- and 5-year survival rates were 78% and 47%, respectively, and were slightly worse with higher DMS grades (P = .02). Risk factors for higher mortality included greater age (P < .0001), atrial fibrillation (P = .0009), renal insufficiency (P = .004), mitral regurgitation (P < .0001), tricuspid regurgitation (P < .0001), elevated right atrial pressure (P < .0001), concomitant aortic stenosis (P = .02), and low serum albumin level (P < .0001). Adjusted for propensity scores, use of renin-angiotensin system blockers (P = .02) or statins (P = .04) was associated with better survival, and use of digoxin was associated with higher mortality (P = .007).
Prognosis in patients with DMS is poor, being worse in the aged and those with renal insufficiency, atrial fibrillation, and other concomitant valvular lesions. Renin-angiotensin system blockers and statins may confer a survival benefit, and digoxin use may be associated with higher mortality in these patients.
在接受二尖瓣和主动脉瓣干预的患者中，严重二尖瓣环钙化导致退行性二尖瓣狭窄（DMS）的情况越来越常见。然而，其临床特征、自然病史以及影响生存的因素仍未得到充分描述。本研究的目的是确定影响DMS患者生存的因素。
在一个机构超声心动图数据库中搜索DMS患者，定义为严重二尖瓣环钙化且无瓣叶融合，平均二尖瓣舒张期压差≥2 mmHg。共纳入1004例患者。分析生存情况与临床、药物和超声心动图变量之间的关系。
患者特征如下：平均年龄73±14岁；73%为女性；49%患有冠状动脉疾病；50%患有糖尿病。1年和5年生存率分别为78%和47%，DMS分级越高生存率略低（P = 0.02）。较高死亡率的危险因素包括年龄较大（P < 0.0001）、心房颤动（P = 0.0009）、肾功能不全（P = 0.004）、二尖瓣反流（P < 0.0001）、三尖瓣反流（P < 0.0001）、右心房压力升高（P < 0.0001）、合并主动脉瓣狭窄（P = 0.02）和血清白蛋白水平低（P < 0.0001）。经倾向评分调整后，使用肾素-血管紧张素系统阻滞剂（P = 0.02）或他汀类药物（P = 0.04）与更好的生存相关，而使用地高辛与更高的死亡率相关（P = 0.007）。
DMS患者预后较差，老年人以及合并肾功能不全、心房颤动和其他瓣膜病变的患者预后更差。肾素-血管紧张素系统阻滞剂和他汀类药物可能带来生存益处，而使用地高辛可能与这些患者的较高死亡率相关。
