Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Heart. 2019 Apr;105(8):609-615. doi: 10.1136/heartjnl-2018-313733. Epub 2018 Oct 20.
Appropriate timing of mitral valve surgery in asymptomatic mitral regurgitation (MR) remains controversial. Peak mitral inflow velocity (peak E wave velocity) has been reported as a simple and easy predictor of quantitative MR severity; however, its prognostic significance in asymptomatic MR remains unclear. Therefore, we sought to investigate the prognostic impact of peak E wave velocity in asymptomatic MR.
Among 529 consecutive patients with degenerative MR of grade 3+ (moderate to severe) or 4+ (severe), 188 asymptomatic patients in sinus rhythm without left ventricular (LV) dysfunction (end-systolic dimension ≥40 mm or ejection fraction <60%) or pulmonary hypertension were studied. Cardiovascular events were defined as a composite endpoint of cardiovascular death or events that indicated mitral surgery including congestive heart failure, atrial fibrillation, LV dysfunction or pulmonary hypertension.
Average peak E wave velocity was 1.05±0.26 m/s, and was significantly higher in grade 4+ than grade 3+ (1.20±0.28 vs 0.98±0.21 m/s, p<0.001). Peak E wave velocity was associated with quantitative MR severity, as well as clinical characteristics of advanced MR (higher brain natriuretic peptide, larger LV and left atrium, higher tricuspid regurgitation pressure gradient and dilated inferior vena cava). During a median follow-up of 4.3 years, 66 (35%) patients developed cardiovascular events. Multivariate Cox proportional hazards analysis showed that peak E wave velocity was an independent predictor of cardiovascular events (adjusted HR 1.245 (95% CI 1.126 to 1.378) per 0.1 m/s, p<0.001).
Peak E wave velocity was an independent predictor of cardiovascular events in asymptomatic degenerative MR with preserved LV function.
无症状性二尖瓣反流（MR）中二尖瓣手术的合适时机仍存在争议。峰值二尖瓣血流速度（峰值 E 波速度）已被报道为定量 MR 严重程度的简单且易于预测的指标；然而，其在无症状性 MR 中的预后意义尚不清楚。因此，我们旨在研究峰值 E 波速度在无症状性 MR 中的预后影响。
在 529 例连续患有 3+ 级（中度至重度）或 4+ 级（重度）退行性 MR 的患者中，有 188 例窦性心律、无左心室（LV）功能障碍（收缩末期直径≥40mm 或射血分数<60%）或肺动脉高压的无症状患者入选。心血管事件定义为心血管死亡或表明二尖瓣手术的事件的复合终点，包括充血性心力衰竭、心房颤动、LV 功能障碍或肺动脉高压。
平均峰值 E 波速度为 1.05±0.26m/s，4+级明显高于 3+级（1.20±0.28 vs. 0.98±0.21m/s，p<0.001）。峰值 E 波速度与定量 MR 严重程度以及晚期 MR 的临床特征相关（较高的脑钠肽、较大的 LV 和左心房、较高的三尖瓣反流压力梯度和扩张的下腔静脉）。在中位数为 4.3 年的随访期间，有 66（35%）例患者发生心血管事件。多变量 Cox 比例风险分析显示，峰值 E 波速度是心血管事件的独立预测因素（每 0.1m/s 的调整后 HR 为 1.245（95%CI 1.126 至 1.378），p<0.001）。
在保留 LV 功能的无症状退行性 MR 中，峰值 E 波速度是心血管事件的独立预测因素。
