经皮二尖瓣球囊成形术成功后维持窦性心律至少10年的二尖瓣狭窄患者的不同特征、临床结局及左心房逆向重构

Different Characteristics, Clinical Outcomes, and Left Atrial Reverse Remodeling in Patients with Mitral Stenosis Maintaining Sinus Rhythm for at Least 10 Years after Successful Percutaneous Mitral Valvuloplasty.

作者信息

Cho In-Jeong, Kim Soo-Jin, Han Donghee, Kim Darae, Shim Chi Young, Hong Geu-Ru, Chang Hyuk-Jae

机构信息

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Cardiology. 2018;140(1):14-20. doi: 10.1159/000486708. Epub 2018 Apr 12.

DOI:10.1159/000486708

PMID:29649813

Abstract

BACKGROUND

We aimed to investigate the characteristics and echocardiographic changes in patients with severe mitral stenosis (MS) who maintained sinus rhythm (SR) for at least 10 years after successful percutaneous mitral balloon valvuloplasty (PMV).

METHODS

We retrospectively reviewed 107 patients who had successful PMV and follow-up echocardiography for at least 10 years without mitral valve surgery. Preprocedural, immediate postprocedural (PMV), and long-term follow-up echocardiography (at least 10 years after PMV) data were reviewed.

RESULTS

The mean follow-up time after PMV was 15 ± 4 years for SR patients (n = 50) and 16 ± 4 years (p = 0.172) for atrial fibrillation (AF) patients (n = 57). The left atrial diameter was significantly decreased in SR patients in the follow-up echocardiography images compared to its pre-PMV value (46.7 ± 6.3 vs. 43.3 ± 6.2 mm, respectively), whereas it was significantly increased in patients with AF (53.9 ± 7.1 vs. 58.1 ± 8.7 mm). In multivariate analysis, preprocedural AF (odds ratio [OR] 14.50, p = 0.001) and LA diameter ≥50 mm (OR 8.81, p < 0.001) were independently associated with increased risk for the presence of AF after successful PMV.

CONCLUSION

Very long-term maintenance of SR after successful PMV was associated with preprocedural SR and LA diameter < 50 mm.

摘要

背景

我们旨在研究成功进行经皮二尖瓣球囊成形术（PMV）后维持窦性心律（SR）至少10年的重度二尖瓣狭窄（MS）患者的特征及超声心动图变化。

方法

我们回顾性分析了107例成功接受PMV且未进行二尖瓣手术并接受至少10年随访超声心动图检查的患者。对术前、术后即刻（PMV）以及长期随访（PMV后至少10年）的超声心动图数据进行了分析。

结果

SR患者（n = 50）PMV后的平均随访时间为15±4年，房颤（AF）患者（n = 57）为16±4年（p = 0.172）。与PMV前相比，随访超声心动图图像中SR患者的左心房直径显著减小（分别为46.7±6.3 vs. 43.3±6.2 mm），而AF患者的左心房直径显著增加（53.9±7.1 vs. 58.1±8.7 mm）。多因素分析显示，术前房颤（比值比[OR] 14.50，p = 0.001）和左心房直径≥50 mm（OR 8.81，p < 0.001）与成功PMV后发生房颤的风险增加独立相关。