Alashi Alaa, Mentias Amgad, Patel Krishna, Gillinov A Marc, Sabik Joseph F, Popović Zoran B, Mihaljevic Tomislav, Suri Rakesh M, Rodriguez L Leonardo, Svensson Lars G, Griffin Brian P, Desai Milind Y
From the Department of Cardiovascular Medicine (A.A., A.M., K.P., Z.B.P., L.L.R., B.P.G., M.Y.D.) and Department of Cardiothoracic Surgery (A.M.G., J.F.S., T.M., R.M.S., L.G.S.), Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, OH.
Circ Cardiovasc Imaging. 2016 Jul;9(7). doi: 10.1161/CIRCIMAGING.115.004451.
In asymptomatic patients with ≥3+ mitral regurgitation and preserved left ventricular (LV) ejection fraction who underwent mitral valve surgery, we sought to discover whether baseline LV global longitudinal strain (LV-GLS) and brain natriuretic peptide provided incremental prognostic utility.
Four hundred and forty-eight asymptomatic patients (61±12 years and 69% men) with ≥3+ primary mitral regurgitation and preserved left ventricular ejection fraction, who underwent mitral valve surgery (92% repair) at our center between 2005 and 2008, were studied. Baseline clinical and echocardiographic data (including LV-GLS using Velocity Vector Imaging, Siemens, PA) were recorded. The Society of Thoracic Surgeons score was calculated. The primary outcome was death. Mean Society of Thoracic Surgeons score, left ventricular ejection fraction, mitral effective regurgitant orifice, indexed LV end-diastolic volume, and right ventricular systolic pressure were 4±1%, 62±3%, 0.55±0.2 cm(2), 58±13 cc/m(2), and 37±15 mm Hg, respectively. Forty-five percent of patients had flail. Median log-transformed BNP and LV-GLS were 4.04 (absolute brain natriuretic peptide: 60 pg/dL) and -20.7%. At 7.7±2 years, death occurred in 41 patients (9%; 0% at 30 days). On Cox analysis, a higher Society of Thoracic Surgeons score (hazard ratio 1.55), higher baseline right ventricular systolic pressure (hazard ratio 1.11), more abnormal LV-GLS (hazard ratio 1.17), and higher median log-transformed BNP (hazard ratio 2.26) were associated with worse longer-term survival (all P<0.01). Addition of LV-GLS and median log-transformed BNP to a clinical model (Society of Thoracic Surgeons score and baseline right ventricular systolic pressure) provided incremental prognostic utility (χ(2) for longer-term mortality increased from 31-47 to 61; P<0.001).
In asymptomatic patients with significant primary mitral regurgitation and preserved left ventricular ejection fraction who underwent mitral valve surgery, brain natriuretic peptide and LV-GLS provided synergistic risk stratification, independent of established factors.
在接受二尖瓣手术的无症状且二尖瓣反流≥3+、左心室（LV）射血分数保留的患者中，我们试图探究基线左心室整体纵向应变（LV-GLS）和脑钠肽是否具有额外的预后价值。
对2005年至2008年间在我们中心接受二尖瓣手术（92%为修复手术）的448例无症状患者（年龄61±12岁，男性占69%）进行研究，这些患者二尖瓣原发性反流≥3+且左心室射血分数保留。记录基线临床和超声心动图数据（包括使用西门子公司的速度向量成像技术测量的LV-GLS）。计算胸外科医师协会评分。主要结局为死亡。胸外科医师协会平均评分、左心室射血分数、二尖瓣有效反流口面积、左心室舒张末期容积指数和右心室收缩压分别为4±1%、62±3%、0.55±0.2 cm²、58±13 cc/m²和37±15 mmHg。45%的患者存在瓣叶脱垂。脑钠肽对数转换中位数和LV-GLS分别为4.04（脑钠肽绝对值：60 pg/dL）和-20.7%。在7.7±2年时，41例患者（9%）死亡（30天时为0%）。在Cox分析中，较高的胸外科医师协会评分（风险比1.55）、较高的基线右心室收缩压（风险比1.11）、更异常的LV-GLS（风险比1.17）和较高的脑钠肽对数转换中位数（风险比2.26）与较差的长期生存率相关（所有P<0.01）。将LV-GLS和脑钠肽对数转换中位数加入临床模型（胸外科医师协会评分和基线右心室收缩压）可提供额外的预后价值（长期死亡率的χ²值从31增至47再增至61；P<0.001）。
在接受二尖瓣手术的无症状、原发性二尖瓣反流严重且左心室射血分数保留的患者中，脑钠肽和LV-GLS提供了协同的风险分层，独立于既定因素。
