Oikawa Masayoshi, Yoshihisa Akiomi, Sato Yu, Nagai Toshiyuki, Yoshikawa Tsutomu, Saito Yoshihiko, Yamamoto Kazuhiro, Takeishi Yasuchika, Anzai Toshihisa
Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, 960-1295, Japan.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Heart Vessels. 2020 Aug;35(8):1087-1094. doi: 10.1007/s00380-020-01581-5. Epub 2020 Mar 19.
A growing body of evidence suggests that mitral regurgitation (MR) is associated with higher mortality in heart failure patients with reduced ejection fraction. However, prognostic impact of MR on heart failure patients with preserved ejection fraction (HFpEF) has not been fully examined. The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, prospective registration of consecutive Japanese hospitalized HFpEF patients with LVEF ≥ 50%. Severe valvular heart disease was excluded from this cohort. We divided the consecutive 341 patients into two groups based on the severity of MR at discharge: no or mild MR group (n = 317) and moderate MR group (n = 24). Compared with no or mild MR group, moderate MR group showed larger left ventricular end-diastolic diameter (52 [48-59] vs. 46 [42-50] mm, P < 0.001), left ventricular systolic diameter (35 [30-37] vs. 29 [26-34] mm, P = 0.006), left atrial diameter (49 [46-56] vs. 45 [40-50] mm, P < 0.001), and higher tricuspid regurgitation peak gradient (33 [25-40] vs. 27 [21-33] mmHg, P = 0.012). In contrast, levels of plasma B-type natriuretic peptide and left ventricular ejection fraction were comparable between the two groups. In the follow-up period (median 738 days), there were 57 all-cause deaths. In the Kaplan-Meier analysis, all-cause mortality was higher in moderate MR group than in no or mild MR group (log-rank P = 0.023). In the Cox proportional hazard analysis, moderate MR at discharge was a predictor of all-cause mortality (hazard ratio 2.256, 95% confidence interval 1.035-4.917, P = 0.041). Moderate MR at discharge is associated with adverse prognosis in hospitalized patients with HFpEF.
越来越多的证据表明，在射血分数降低的心力衰竭患者中，二尖瓣反流（MR）与更高的死亡率相关。然而，MR对射血分数保留的心力衰竭患者（HFpEF）的预后影响尚未得到充分研究。日本射血分数保留的心力衰竭综合征（JASPER）登记研究是一项针对连续住院的LVEF≥50%的日本HFpEF患者进行的全国性、观察性、前瞻性登记研究。该队列排除了严重瓣膜性心脏病患者。我们根据出院时MR的严重程度将连续的341例患者分为两组：无或轻度MR组（n = 317）和中度MR组（n = 24）。与无或轻度MR组相比，中度MR组的左心室舒张末期直径更大（52 [48 - 59] vs. 46 [42 - 50] mm，P < 0.001），左心室收缩期直径更大（35 [30 - 37] vs. 29 [26 - 34] mm，P = 0.006），左心房直径更大（49 [46 - 56] vs. 45 [40 - 50] mm，P < 0.001），三尖瓣反流峰值梯度更高（33 [25 - 40] vs. 27 [21 - 33] mmHg，P = 0.012）。相比之下，两组间血浆B型利钠肽水平和左心室射血分数相当。在随访期（中位738天），共有57例全因死亡。在Kaplan - Meier分析中，中度MR组的全因死亡率高于无或轻度MR组（对数秩检验P = 0.023）。在Cox比例风险分析中，出院时中度MR是全因死亡率的预测因素（风险比2.256，95%置信区间1.035 - 4.917，P = 0.041）。出院时中度MR与住院HFpEF患者的不良预后相关。
