基于性别的严重缺血性二尖瓣反流患者行二尖瓣手术治疗后的结局差异：来自心胸外科手术试验网络。
Sex-Based Differences in Outcomes After Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation: From the Cardiothoracic Surgical Trials Network.
机构信息
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
JACC Heart Fail. 2019 Jun;7(6):481-490. doi: 10.1016/j.jchf.2019.03.001.
OBJECTIVES
This study investigated sex-based differences in outcomes after mitral valve (MV) surgery for severe ischemic mitral regurgitation (SIMR).
BACKGROUND
Whether differences in outcomes exist between men and women after surgery for SIMR remains unknown.
METHODS
Patients enrolled in a randomized trial comparing MV replacement versus MV repair for SIMR were included and followed for 2 years. Endpoints for this analysis included all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE) (defined as the composite of death, stroke, hospitalization for heart failure, worsening New York Heart Association functional class or MV re-operation), quality of life (QOL), functional status, and percentage of change in left ventricular end-systolic volume index (LVESVI) from baseline through 2 years.
RESULTS
Of 251 patients enrolled in the trial, 96 (38.2%) were women. Compared with men, women had smaller LV volumes and effective regurgitant orifice areas (EROA) but greater EROA/left ventricular (LV) end-diastolic volume ratios. At 2 years, women had higher rates of all-cause mortality (27.1% vs. 17.4%, respectively; adjusted hazard ratio [adjHR]: 1.85; 95% confidence interval [CI]: 1.05 to 3.26; p = 0.03) and of MACCE (49.0% vs. 38.1%, respectively; adjHR: 1.58; 95% CI: 1.06 to 2.37; p = 0.02). Women also reported worse QOL and functional status at 2 years. There were no significant differences in the percentage of change over 2 years in LVESVI between women and men (adjβ: -10.4; 95% CI: -23.4 to 2.6; p = 0.12).
CONCLUSIONS
Women with SIMR displayed different echocardiographic features and experienced higher mortality and worse QOL after MV surgery than men. There were no significant differences in the degree of reverse LV remodeling between sexes. (Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation [Severe Ischemic Mitral Regurgitation]; NCT00807040).
目的
本研究旨在探讨二尖瓣（MV）手术治疗严重缺血性二尖瓣反流（SIMR）患者的结局是否存在性别差异。
背景
目前仍不清楚 SIMR 手术后男性和女性的结局是否存在差异。
方法
本研究纳入了一项比较 SIMR 患者行 MV 置换术与 MV 修复术的随机临床试验，并对患者进行了为期 2 年的随访。本分析的终点包括全因死亡率、主要不良心血管和脑血管事件（MACCE）（定义为死亡、卒中等复合终点）、生活质量（QOL）、功能状态以及 2 年时左心室收缩末期容积指数（LVESVI）的变化百分比。
结果
在这项临床试验中，共纳入了 251 例患者，其中 96 例（38.2%）为女性。与男性相比，女性的 LV 容积和有效反流口面积较小，但反流口面积/左心室（LV）舒张末期容积比值较大。2 年时，女性的全因死亡率（27.1%比 17.4%；校正后的危险比 [adjHR]：1.85；95%置信区间 [CI]：1.05 至 3.26；p=0.03）和 MACCE 发生率（49.0%比 38.1%；adjHR：1.58；95%CI：1.06 至 2.37；p=0.02）均较高。2 年时，女性的 QOL 和功能状态也较差。女性和男性在 2 年时 LVESVI 的变化百分比无显著差异（adjβ：-10.4；95%CI：-23.4 至 2.6；p=0.12）。
结论
与男性相比，患有 SIMR 的女性具有不同的超声心动图特征，在接受 MV 手术后死亡率更高，QOL 更差。但在 LV 反向重构的程度上，男女之间没有显著差异。（比较严重慢性缺血性二尖瓣反流患者修复与置换心脏二尖瓣的效果[严重缺血性二尖瓣反流]；NCT00807040）。
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