Miura Shiro, Arita Takeshi, Domei Takenori, Yamaji Kyohei, Soga Yoshimitsu, Hyodo Makoto, Shirai Shinichi, Ando Kenji
Department of Social, Human and Mathematical Sciences, University of Southampton, Highfield, Southampton, Hampshire, SO17 1BJ, UK.
Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
Cardiovasc Interv Ther. 2018 Jan;33(1):46-54. doi: 10.1007/s12928-016-0434-9. Epub 2016 Oct 5.
Optimal time to perform percutaneous mitral valvuloplasty (PMV) for patients with significant mitral stenosis (MS) and atrial fibrillation (AF) remains controversial. We sought to identify prognostic factors and evaluate long-term clinical outcomes after PMV of 77 consecutive patients with MS with a mitral valve area (MVA) <1.5 cm. According to baseline heart rhythm, these patients were divided into sinus rhythm (SR; n = 24) and AF (n = 53) groups. The study endpoint was defined as a composite of all-cause mortality, admission for heart failure, mitral valve surgery, repeated PMV, and major cerebral vascular accident during follow-up. After successful PMV, there was no significant difference between the two groups in post-MVA and post-mitral mean pressure gradient. However, the New York Heart Association Functional Classification post-procedure was worse in the AF group (p < 0.01). In the AF group, event-free survival during follow-up was significantly lower compared with that of the SR group (p = 0.016). Independent predictors of clinical events were AF [hazard ratio (HR), 2.73; 95 % confidence interval (CI), 1.04-9.36; p = 0.03] and pulmonary artery systolic pressure (HR 2.57; 95 % CI 1.18-5.47; p = 0.017). Patients with AF at baseline were significantly associated with worse symptoms and higher event rates after successful PMV compared with those with SR. The clinical benefit of PMV may be considered for patients with MVA <1.5 cm before the onset of AF.
对于患有严重二尖瓣狭窄（MS）和心房颤动（AF）的患者，进行经皮二尖瓣球囊成形术（PMV）的最佳时机仍存在争议。我们试图确定77例二尖瓣面积（MVA）<1.5 cm²的MS连续患者在PMV后的预后因素并评估其长期临床结局。根据基线心律，这些患者被分为窦性心律（SR；n = 24）和AF（n = 53）组。研究终点定义为随访期间全因死亡率、心力衰竭住院、二尖瓣手术、重复PMV和重大脑血管意外的综合指标。成功进行PMV后，两组在术后MVA和二尖瓣平均压力阶差方面无显著差异。然而，AF组术后纽约心脏协会功能分级更差（p < 0.01）。在AF组中，随访期间无事件生存率显著低于SR组（p = 0.016）。临床事件的独立预测因素是AF [风险比（HR），2.73；95%置信区间（CI），1.04 - 9.36；p = 0.03]和肺动脉收缩压（HR 2.57；95% CI 1.18 - 5.47；p = 0.017）。与SR患者相比，基线时患有AF的患者在成功进行PMV后症状更差且事件发生率更高。对于AF发作前MVA <1.5 cm²的患者，可考虑PMV的临床益处。
