Cho In Jeong, Jeong Hyeonju, Choi Jah Yeon, Lee Sang Eun, Chang Hyuk Jae
Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Myungji Hospital, Goyang, Korea.
J Cardiovasc Imaging. 2019 Apr;27(2):122-133. doi: 10.4250/jcvi.2019.27.e20.
Limited data are available on the prognosis of progressive mitral stenosis (MS). We evaluated the factors associated with adverse events in patients with progressive MS.
We retrospectively analyzed 259 consecutive patients with pure progressive MS with a mitral valve area (MVA) between 1.5 and 2.0 cm². The primary outcome measures were a composite endpoint of cardiac death, heart failure hospitalization, mitral valve surgery or percutaneous mitral valvuloplasty, and ischemic stroke.
The mean patient age was 62 ± 12 years, and the mean MVA was 1.71 ± 0.15 cm². Over a median follow-up duration of 52 months, a total of 41 patients (18.3%) experienced the composite endpoint. In multivariable Cox regression analysis, prior stroke (hazard ratio [HR], 4.54; 95% confidence interval [CI], 2.16-9.54; p < 0.001) and left atrial volume index (LAVI) of > 50 mL/m² (HR, 4.45; 95% CI, 1.31-15.31; p = 0.017) were identified as independent predictors of the composite endpoint, even after adjusting for age and sex. Patients with a LAVI ≤ 50 mL/m² demonstrated favorable event-free survival compared with those with a LAVI > 50 mL/m² in either the overall population (p < 0.001) or asymptomatic patients (p = 0.002). Atrial fibrillation (AF), left ventricular mass index (LVMI), MVA, and mean diastolic pressure were factors independently associated with LAVI (all p < 0.05).
A deleterious impact of a high LAVI on outcome was observed in patients with progressive MS. The LAVI was mainly influenced by the presence of AF, the severity of MS, and LVMI in this population.
关于进展性二尖瓣狭窄（MS）预后的数据有限。我们评估了进展性MS患者不良事件的相关因素。
我们回顾性分析了259例连续性单纯进展性MS患者，其二尖瓣瓣口面积（MVA）在1.5至2.0cm²之间。主要结局指标为心脏性死亡、心力衰竭住院、二尖瓣手术或经皮二尖瓣球囊成形术以及缺血性卒中的复合终点。
患者平均年龄为62±12岁，平均MVA为1.71±0.15cm²。在中位随访期52个月内，共有41例患者（18.3%）发生复合终点事件。在多变量Cox回归分析中，既往卒中（风险比[HR]，4.54；95%置信区间[CI]，2.16 - 9.54；p < 0.001）和左心房容积指数（LAVI）>50mL/m²（HR，4.45；95%CI，1.31 - 15.31；p = 0.017）被确定为复合终点事件的独立预测因素，即使在调整年龄和性别后也是如此。在总体人群（p < 0.001）或无症状患者（p = 0.002）中，LAVI≤50mL/m²的患者与LAVI>50mL/m²的患者相比，无事件生存率更佳。心房颤动（AF）、左心室质量指数（LVMI）、MVA和平均舒张压是与LAVI独立相关的因素（均p < 0.05）。
在进展性MS患者中观察到高LAVI对结局有有害影响。在该人群中，LAVI主要受AF的存在、MS的严重程度和LVMI的影响。
