The Division of Cardiology, Department of Medicine, University of California, Sulpizio Cardiovascular Center, San Diego, California.
The Division of Cardiology, Department of Medicine, University of California, Sulpizio Cardiovascular Center, San Diego, California.
Am J Cardiol. 2019 Apr 15;123(8):1309-1313. doi: 10.1016/j.amjcard.2019.01.026. Epub 2019 Jan 24.
Risk factors predicting progression from low grade to severe mitral regurgitation (MR), which is a guideline criterion for surgical intervention, remain unknown. We hypothesized that abnormalities of cardiac structure and function may predict progression in MR severity. We followed 82 asymptomatic mitral valve prolapse (MVP) patients (65 ± 12 years, 51% men) with mild or moderate MR (36 mild, 46 moderate, mean LVEF: 62%), without significant co-morbidities. We examined clinical findings and 13 echo measurements. The primary end point was progression to severe MR. In a mean follow-up period of 4.5 ± 2.7 years, mortality and heart failure development were similar for mild and moderate MR. No mild MR patient progressed to severe, but 23 moderate MR patients (50.0%) progressed to severe with 9 patients (39.1%) who underwent surgery. No clinical variables were predictive for progression. Only mean mitral annulus diameter (apical 4 and 2 chamber) was predictive for progression to severe MR (hazards ratio 1.14, 95% confidence interval 1.03 to 1.26, p = 0.01). A cut-off annulus diameter of 39.6 mm had a good accuracy (area under the curve 0.78, sensitivity 100%, and specificity 63.8%) for progression to severe. In conclusion, over a 4.5-year period, 50% of asymptomatic MVP patients with moderate MR, but none with mild, progressed to severe MR. Only mitral annular dimension predicted progression of moderate to severe MR, and values >39.6 mm predicted progression accurately. Mitral annulus diameter may be of value in identifying asymptomatic MVP patients at risk of developing severe MR.
预测从轻度发展为重度二尖瓣反流（MR）的风险因素（重度 MR 是手术干预的指南标准）仍然未知。我们假设心脏结构和功能的异常可能预测 MR 严重程度的进展。我们随访了 82 例无症状二尖瓣脱垂（MVP）患者（65 ± 12 岁，51%为男性），这些患者有轻度或中度 MR（36 例轻度，46 例中度，平均 LVEF：62%），没有明显的合并症。我们检查了临床发现和 13 项超声测量结果。主要终点是进展为重度 MR。在平均 4.5 ± 2.7 年的随访期间，轻度和中度 MR 的死亡率和心力衰竭发生率相似。没有轻度 MR 患者进展为重度，但 23 例中度 MR 患者（50.0%）进展为重度，其中 9 例（39.1%）接受了手术。没有临床变量可预测进展。只有平均二尖瓣环直径（心尖 4 腔和 2 腔）可预测进展为重度 MR（风险比 1.14，95%置信区间 1.03 至 1.26，p = 0.01）。环直径为 39.6mm 的截断值对进展为重度具有良好的准确性（曲线下面积 0.78，灵敏度 100%，特异性 63.8%）。总之，在 4.5 年的时间里，50%的无症状 MVP 患者伴有中度 MR，但无一例伴有轻度 MR，进展为重度 MR。只有二尖瓣环直径预测了中度至重度 MR 的进展，而 >39.6mm 的值可以准确预测进展。二尖瓣环直径可能有助于识别有发展为重度 MR 风险的无症状 MVP 患者。
