Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.
JACC Heart Fail. 2017 Sep;5(9):652-659. doi: 10.1016/j.jchf.2017.06.015.
The purpose of this study was to assess whether medical management may alter the severity of functional mitral regurgitation (FMR) and its prognosis in patients who have heart failure with reduced ejection fraction (HFrEF).
FMR in patients who have HFrEF is associated with a worse prognosis. It is uncertain to what extent medical management may alter the severity of FMR and its prognosis.
The extent of FMR was assessed at baseline and after a median follow-up period of 50 months in 163 consecutive HFrEF patients (left ventricular ejection fraction <40%). Severe FMR was defined as mitral regurgitation (MR) grade 3-4. All of the patients received the maximal tolerable doses of their heart failure (HF) medications. Major adverse cardiac events were defined as a composite of all-cause death and the need for heart transplantation or hospitalization for HF and/or malignant arrhythmias.
A total of 50 (31%) patients had severe MR at baseline. During the follow-up period, 38% of the severe FMR patients showed an improvement to nonsevere FMR (MR grade <3), whereas 18% of the nonsevere FMR patients developed severe FMR despite optimal HF treatment. Cox regression analysis revealed that the presence of sustained severe FMR or worsening of FMR was the most important independent prognostic determinant with an adjusted odds ratio of 2.5 (95% confidence interval: 1.5 to 4.3, major adverse cardiac events 83% vs. 43%). In addition, those patients showed a 13% increase in left ventricular end-diastolic volume index (LVEDVI), whereas the patients with improvement in their severe MR showed a 2% decrease in LVEDVI (p = 0.01).
Severe FMR was successfully treated with medication in almost 40% and was associated with prevention of left ventricular adverse remodeling and with an improved long-term prognosis.
本研究旨在评估对于射血分数降低的心力衰竭（HFrEF）患者，药物治疗是否会改变功能性二尖瓣反流（FMR）的严重程度及其预后。
对于 HFrEF 患者，FMR 与预后较差相关。药物治疗在多大程度上改变 FMR 的严重程度及其预后尚不确定。
在 163 例连续的 HFrEF 患者（左心室射血分数 <40%）中，在基线时和中位随访 50 个月时评估 FMR 的严重程度。重度 FMR 定义为二尖瓣反流（MR）3-4 级。所有患者均接受心力衰竭（HF）药物的最大耐受剂量治疗。主要心脏不良事件定义为全因死亡和需要心脏移植或因 HF 和/或恶性心律失常住院的复合终点。
共有 50 例（31%）患者在基线时存在重度 MR。在随访期间，38%的重度 FMR 患者的 FMR 严重程度改善至非重度 FMR（MR 分级<3），而 18%的非重度 FMR 患者尽管接受了最佳 HF 治疗，但仍发展为重度 FMR。Cox 回归分析显示，持续性重度 FMR 或 FMR 恶化是最重要的独立预后预测因素，校正比值比为 2.5（95%置信区间：1.5 至 4.3，主要不良心脏事件发生率 83%与 43%）。此外，这些患者的左心室舒张末期容积指数（LVEDVI）增加了 13%，而重度 MR 改善的患者的 LVEDVI 降低了 2%（p=0.01）。
通过药物治疗，近 40%的重度 FMR 得到成功治疗，与预防左心室不良重构和改善长期预后相关。
