Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands.
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, New York.
Am J Cardiol. 2019 Jan 1;123(1):75-83. doi: 10.1016/j.amjcard.2018.09.020. Epub 2018 Sep 26.
Functional mitral regurgitation (FMR) is common in heart failure (HF), and negatively impacts prognosis. Cardiac resynchronization therapy (CRT) can improve FMR, but the long-term changes in and impact of FMR after CRT are still unclear. The present study investigated the prevalence, evolution and impact on mortality of FMR before and after CRT in patients with HF. A total of 1,313 patients (66 ± 11 years, 77% male, 59% ischemic heart disease) treated with CRT were evaluated. Patients were divided into 4 groups of FMR according to the evolution at 6 months after CRT: no or mild FMR at baseline which remained unchanged at 6 months (grade 0-1 FMR unchanged, n = 609 [51%]), no or mild FMR which worsened to moderate to severe (grade 0-1 FMR worsened, n = 66 [6%)]), moderate to severe FMR which improved to no or mild (grade 2-4 improved, n = 209 [18%]), and moderate to severe FMR which remained unchanged (grade 2-4 unchanged, n = 309 [26%]). Over a mean follow-up of 51 ± 38 months, 297 (25%) patients died. Those with baseline FMR grade 0-1 which remained unchanged at 6-month follow-up, as well as baseline FMR grade 2-4 which improved, had lower mortality rates than patients with 6-month FMR grade 2-4 regardless of baseline FMR grade (p <0.001). Baseline FMR grade 2-4 that remained unchanged at 6-month follow-up was associated with increased mortality, independent of the clinical and left ventricular volumetric responses to CRT (hazard ratio, 1.77; 95% confidence interval, 1.41-2.22, p <0.001). In conclusion, moderate to severe FMR at baseline which remains unchanged at 6 months after CRT implantation is strongly associated with long-term mortality in patients with HF.
功能性二尖瓣反流（FMR）在心力衰竭（HF）中很常见，并且对预后有负面影响。心脏再同步治疗（CRT）可以改善 FMR，但 CRT 后 FMR 的长期变化及其对死亡率的影响仍不清楚。本研究调查了 HF 患者 CRT 前后 FMR 的患病率、演变及其对死亡率的影响。共评估了 1313 例接受 CRT 治疗的患者（66 ± 11 岁，77%为男性，59%为缺血性心脏病）。根据 CRT 后 6 个月的演变，患者分为 4 组 FMR：基线时无或轻度 FMR 且 6 个月时无变化（0-1 级 FMR 不变，n=609[51%]）、基线时无或轻度 FMR 恶化至中重度（0-1 级 FMR 恶化，n=66[6%]）、中重度 FMR 改善至无或轻度（2-4 级改善，n=209[18%]）和中重度 FMR 不变（2-4 级不变，n=309[26%]）。平均随访 51 ± 38 个月后，有 297 例（25%）患者死亡。与 6 个月时 FMR 为 2-4 级的患者相比，基线 FMR 为 0-1 级且 6 个月时无变化的患者以及基线 FMR 为 2-4 级且改善的患者的死亡率更低（p<0.001）。6 个月时 FMR 为 2-4 级不变的患者与基线 FMR 为 2-4 级不变的患者相比，死亡率升高，与 CRT 对临床和左心室容积的反应无关（风险比，1.77；95%置信区间，1.41-2.22，p<0.001）。总之，HF 患者 CRT 植入后 6 个月时基线中度至重度 FMR 不变与长期死亡率密切相关。
