Zhuge Rui-Qi, Hou Xiao-Pei, Qi Xi-Ling, Wu Yong-Jian, Zhang Ming-Zi
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Geriatr Cardiol. 2018 Jun;15(6):428-433. doi: 10.11909/j.issn.1671-5411.2018.06.005.
To summarize clinical characteristics and treatment strategy of Chinese elderly mitral regurgitation (MR) inpatients under the current guidelines, and to identify factors related to treatment options in them.
A single center retrospective study was conducted in which patients hospitalized in Fuwai hospital from May 1 of 2014 to April 30 of 2015 with moderate to severe MR assessed by transthoracic echocardiography were enrolled consecutively ( = 1741). Patients > 60 years old were grouped as elderly group ( = 680) and patients < 60 years were grouped as control group ( = 1061). The elderly group was categorized into two subgroups based on surgical status.
s The mean age of the elderly group was 66.98 ± 5.94 years. The most common reason of MR in elderly group was degenerative MR (41.18%). Atherosclerotic risk factors such as hypertension, diabetes or hyperlipidaemia were more commonly observed in elderly group than the control group (45.44% . 25.17%, < 0.001; 19.56% . 8.48%, < 0.001; 35.29% . 19.51%, < 0.001). Elderly group had higher EuroscoreIIscore (5.54 ± 2.42 3.15 ± 1.66), greater left ventricular end diastolic diameter (LVEDD) (57.72 ± 12.3 . 57.33 ± 10.19 mm) and a lower surgery rate (54.71% 63.91%); < 0.05. Age, left ventricular ejection fraction (LVEF), regurgitation grade, EuroScore-II high risk stratification and having diabetes were identified as factors associated with therapy decisions in elderly MR patients.
Valve surgery was denied in 45.29% of elderly MR inpatients. Older age, impaired LVEF, lower regurgitation grade, EuroScore-II high risk stratification, and having diabetes were factors most significantly associated with surgery denial among elderly Chinese inpatients with MR.
总结现行指南下中国老年二尖瓣反流（MR）住院患者的临床特征及治疗策略，并确定与他们治疗选择相关的因素。
进行一项单中心回顾性研究，连续纳入2014年5月1日至2015年4月30日在阜外医院住院、经胸超声心动图评估为中重度MR的患者（n = 1741）。年龄>60岁的患者分为老年组（n = 680），年龄<60岁的患者分为对照组（n = 1061）。老年组根据手术状态分为两个亚组。
老年组的平均年龄为66.98±5.94岁。老年组MR最常见的原因是退行性MR（41.18%）。老年组中高血压、糖尿病或高脂血症等动脉粥样硬化危险因素的发生率高于对照组（45.44%对25.17%，P<0.001；19.56%对8.48%，P<0.001；35.29%对19.51%，P<0.001）。老年组的欧洲心脏手术风险评估系统II（EuroscoreII）评分更高（5.54±2.42对3.15±1.66），左心室舒张末期内径（LVEDD）更大（57.72±12.3对57.33±10.19mm），手术率更低（54.71%对63.91%）；P<0.05。年龄、左心室射血分数（LVEF）、反流分级、EuroScore-II高风险分层和患有糖尿病被确定为老年MR患者治疗决策的相关因素。
45.29%的老年MR住院患者未接受瓣膜手术。年龄较大、LVEF受损、反流分级较低、EuroScore-II高风险分层以及患有糖尿病是老年中国MR住院患者中与手术未接受最显著相关的因素。
