Park Sung-Ji, Cho Eun Jeong, Ahn Joonghyun, Carriere Keumhee, Kim Eun Kyoung, Lee Ga Yeon, Chang Sung-A, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo
Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, National Cancer Center, Goyang, Republic of Korea.
Int J Cardiol. 2017 Jun 1;236:387-392. doi: 10.1016/j.ijcard.2017.02.063. Epub 2017 Feb 24.
Exercise stress echocardiography (ESE) can be used to identify left ventricular (LV) dysfunction in asymptomatic chronic MR. NT-proBNP is the best marker for monitoring LV dysfunction.
The aim of this study was to estimate the complementary prognostic value of ESE and NT-proBNP in asymptomatic degenerative MR with preserved LV ejection fraction (EF).
Symptom-limited treadmill ESE was performed in 114 asymptomatic with significant degenerative MR (ERO >20mm, RV >30ml), LV end-systolic diameter <40mm and preserved LV function (EF >60%). Post-exercise EF increase of >4% was defined as contractile reserve (CR)+.
MV operation was performed in 19 (16.7%) and new-onset LV systolic dysfunction was developed in 23 (20.2%) patients over 3.5±1.5years. Based on ROC curve analysis, a NT-pro BNP of 100 was deemed the most relevant cutoff value to predict primary outcome with Youden's index=131.84. In sequential Cox models, a model based on clinical data and resting echocardiography variables (χ=6.87) was improved by NT-proBNP (χ=13.9) and presence of CR in ESE (χ=20.8; p=0.0002).
In asymptomatic moderate to severe or severe degenerative MR and preserved LVEF, the presence of CR in ESE and NT-proBNP provide important incremental clinical determinants. In particular, the prognosis is markedly poor for those with high NT-proBNP but with absence of CR than low NT-proBNP with presence of CR.
运动负荷超声心动图（ESE）可用于识别无症状慢性二尖瓣反流（MR）患者的左心室（LV）功能障碍。N末端脑钠肽前体（NT-proBNP）是监测LV功能障碍的最佳标志物。
本研究旨在评估ESE和NT-proBNP在左心室射血分数（EF）保留的无症状退行性MR中的互补预后价值。
对114例无症状的重度退行性MR（有效反流口面积>20mm，反流容积>30ml）、LV收缩末期内径<40mm且LV功能保留（EF>60%）的患者进行症状限制性平板运动ESE检查。运动后EF增加>4%定义为有收缩储备（CR）+。
在3.5±1.5年期间，19例（16.7%）患者接受了二尖瓣手术，23例（20.2%）患者出现了新发LV收缩功能障碍。基于ROC曲线分析，NT-pro BNP为100被认为是预测主要结局的最相关临界值，约登指数=131.84。在序贯Cox模型中，基于临床数据和静息超声心动图变量的模型（χ=6.87）通过NT-proBNP（χ=13.9）和ESE中CR的存在（χ=20.8；p=0.0002）得到了改善。
在无症状的中重度或重度退行性MR且LVEF保留的患者中，ESE中CR和NT-proBNP的存在提供了重要的额外临床决定因素。特别是，NT-proBNP高但无CR的患者的预后明显比NT-proBNP低但有CR的患者差。
