二尖瓣钙化评估：球囊瓣膜成形术结果的独立预测指标。
Mitral valve calcium assessment: An independent predictor of balloon valvuloplasty results.
作者信息
Sarmiento Ricardo A, Solernó Raúl, Blanco Rodrigo, Giachello Federico, Hauqui Agustin, Oscos Martín, Blanco Federico, Gigena Gerardo, Lax Jorge, Pedroni Pablo
机构信息
Department of Interventional Cardiology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina; Department of Interventional Cardiology, Hospital de Alta Complejidad en Red - El Cruce, Florencio Varela, Argentina.
Department of Interventional Cardiology, Hospital de Alta Complejidad en Red - El Cruce, Florencio Varela, Argentina.
出版信息
Indian Heart J. 2019 Nov-Dec;71(6):454-458. doi: 10.1016/j.ihj.2019.10.003. Epub 2019 Oct 22.
OBJECTIVE
Percutaneous mitral valvuloplasty (PMV) is an effective treatment for patients with mitral valve stenosis. Echocardiographic score (ES) is a useful predictor of outcomes. However, mitral valve calcification (MVC) has been shown to predict immediate results even in patients with otherwise low ES. We sought to evaluate the usefulness of MVC assessment as a predictor of immediate and long-term outcomes after PMV.
METHODS
PMV was performed in 168 consecutive patients. Clinical and echocardiographic variables were analyzed. Patients were classified into 2 groups: group 1: minimal MVC and group 2: moderate to severe MVC. Primary success was defined as post-PMV mitral valve area (MVA) ≥ 1.5 cm in the absence of major complications. Restenosis (RE) was defined as a decrease in MVA >50% of initial gain or a final MVA <1.5 cm.
RESULTS
Mean age was 46.5 ± 11 years, and 86.9% (146) were women. Forty-two patients (25%) had mild MVC (group 1), and 75% of the patients had moderate to severe MVC (group 2). Procedural success was achieved in 95.2% and 76.2% for groups 1 and 2, respectively, p = 0.01. MVA after PMV was 1.82 cm (IQR 25-75 = 1.60-2.00) in group 1 and 1.67 cm (IQR 25-75 = 1.44-1.97) in group 2, p = 0.02. After 48 months, 28.2% of patients presented RE. Multivariate analysis identified the presence of MVC as an independent predictor of poor immediate results (HR = 0.12, 95% IC 0.03-0.91) and RE (HR = 1.94, 95% CI = 1.02-5.21).
CONCLUSION
Our study shows that the presence of MVC may predict immediate and long-term outcomes after PMV.
目的
经皮二尖瓣球囊成形术（PMV）是二尖瓣狭窄患者的一种有效治疗方法。超声心动图评分（ES）是预后的一个有用预测指标。然而，二尖瓣钙化（MVC）已被证明即使在ES较低的患者中也能预测即刻结果。我们试图评估MVC评估作为PMV后即刻和长期预后预测指标的有效性。
方法
对168例连续患者进行PMV。分析临床和超声心动图变量。患者分为两组：第1组：轻度MVC和第2组：中度至重度MVC。主要成功定义为PMV后二尖瓣面积（MVA）≥1.5 cm²且无主要并发症。再狭窄（RE）定义为MVA下降超过初始增加量的50%或最终MVA<1.5 cm²。
结果
平均年龄为46.5±11岁，86.9%（146例）为女性。42例患者（25%）有轻度MVC（第1组），75%的患者有中度至重度MVC（第2组）。第1组和第2组的手术成功率分别为95.2%和76.2%，p = 0.01。第1组PMV后的MVA为1.82 cm²（IQR 25-75 = 1.60-2.00），第2组为1.67 cm²（IQR 25-75 = 1.44-1.97），p = 0.02。48个月后，28.2%的患者出现RE。多变量分析确定MVC的存在是即刻结果不佳（HR = 0.12，95% IC 0.03-0.91）和RE（HR = 1.94，95% CI = 1.02-5.21）的独立预测指标。
结论
我们的研究表明，MVC的存在可能预测PMV后的即刻和长期预后。
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