Heart Center, Universitair Ziekenhuis Ghent, Ghent, Belgium
Heart Center, Universitair Ziekenhuis Ghent, Ghent, Belgium.
Heart. 2020 Jun;106(12):904-909. doi: 10.1136/heartjnl-2019-316157. Epub 2020 Mar 22.
Echocardiographic grading of secondary mitral regurgitation (SMR) severity is challenging and involves multiple guideline-recommended parameters. We previously introduced the average pixel intensity (API) method for grading SMR. In this study, the clinical outcome in SMR based on the API method for grading MR was compared with conventional grading methods.
231 patients with systolic heart failure and reduced ejection fraction (ischaemic/non-ischaemic) and SMR were prospectively enrolled. MR was graded using all guideline-recommended parameters and the API method, which is based on the pixel intensity of the continuous wave Doppler signal. The primary outcome was MACE (major adverse cardiac event).
The API method was applicable in 98% of patients with SMR (n=227). During a median follow-up of 24 months, 98 patients (43%) had a MACE (cardiovascular mortality (n=50, 22%), heart failure hospitalisation (n=44, 19%), mitral valve surgery (n=11, 5%), percutaneous mitral intervention (n=12, 5%), heart transplantation (n=5, 2%)). On log-rank test, the API method was highly significant in predicting clinical outcome. On multivariable Cox proportional hazard analysis, SMR grading with the API method was an independent predictor of clinical outcome (along with NYHA class and right ventricular systolic pressure; p<0.001), increasing the event risk by 9% per 10 au API rise (p=0.001). In the same multivariable analysis, proximal isovelocity surface area (PISA)-effective regurgitant orifice area or PISA-regurgitant volume were not independent predictors of events (p=0.18 and 0.26, respectively).
SMR grading with the API method is an independent predictor of clinical outcome and provides prognostic information in addition to clinical and other echocardiographic variables.
超声心动图对继发性二尖瓣反流（SMR）严重程度的分级具有挑战性，涉及多个指南推荐的参数。我们之前介绍了用于分级 SMR 的平均像素强度（API）方法。在这项研究中，我们比较了基于 API 方法分级 MR 的 SMR 的临床结果与传统分级方法。
前瞻性纳入 231 例射血分数降低的收缩性心力衰竭（缺血性/非缺血性）伴 SMR 的患者。使用所有指南推荐的参数和基于连续波多普勒信号像素强度的 API 方法对 MR 进行分级。主要终点是 MACE（主要不良心脏事件）。
API 方法适用于 98%的 SMR 患者（n=227）。在中位随访 24 个月期间，98 例患者（43%）发生 MACE（心血管死亡率（n=50，22%）、心力衰竭住院（n=44，19%）、二尖瓣手术（n=11，5%）、经皮二尖瓣介入（n=12，5%）、心脏移植（n=5，2%））。对数秩检验显示，API 方法对预测临床结局具有高度显著性。多变量 Cox 比例风险分析显示，API 法分级 SMR 是临床结局的独立预测因素（与 NYHA 分级和右心室收缩压相关；p<0.001），API 每增加 10 au，事件风险增加 9%（p=0.001）。在相同的多变量分析中，近端等速表面积（PISA）-有效反流口面积或 PISA-反流容积不是事件的独立预测因素（分别为 p=0.18 和 0.26）。
API 方法分级 SMR 是临床结局的独立预测因素，除了临床和其他超声心动图变量外，还提供预后信息。
