Division of Cardiology, Department of Internal Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
Department of General Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou.
Medicine (Baltimore). 2021 Jul 30;100(30):e26594. doi: 10.1097/MD.0000000000026594.
To investigate long-term cardiac remodeling and prognosis of patients post-left-ventricular valve replacement, and explored related risk factors of heart failure and management strategies. Retrospective cohort of patients with left-ventricular valve replacement between 2005 and 2007. Major adverse cardiac events were recorded, including death, hospitalization, stroke, and New York Heart Association (NYHA) functional classifications. Cardiac remodeling was assessed by comparing pre-operative, post-operative, and follow-up echocardiographic images. (1).. Two hundred fifty-seven patients who received left-ventricular mitral, aortic, or double-valve replacement surgery were followed up for 10.4 ± 1.5 years with an all-cause mortality rate 18.7% and an incidence of heart failure that significantly restricted daily life (NYHA III or IV) 21.3%. (2).. There were no significant differences in classic cardiac-remodeling variables between baseline and long-term follow-up, such as left-ventricular diameter (47.9 ± 8.3 vs 49.9 ± 8.0 mm, = .14) and left-ventricular ejection fraction (58.6 ± 9.6% vs 57.0 ± 10.3%, = .34), whereas there were significant differences in terms of left-atrial anteroposterior diameter (LA) (39.7 ± 9.5 vs 49.0 ± 14.3 mm, < .001) and tricuspid regurgitation (TR) (1.4 ± 1.0 vs 2.2 ± 1.2, < .001). Multivariable logistic regression analysis showed that LA ≥ 50 mm ( = .011) and more than moderate tricuspid regurgitation (TR > 2) ( = .012) were associated with poor prognoses for long-term consequences of heart failure. Both LA and TR progressed with the length of time after surgery. LA enlargement and TR after left-ventricular valve replacement surgery were time-dependent events, which represented cardiac remodeling and were closely related to post-operative long-term consequences of heart failure. It is important to be cognizant of and to explore long-term preventive and treatment strategies for adverse cardiac events in patients following left-ventricular valve replacement.
为了研究左心瓣膜置换术后患者的长期心脏重构和预后，并探讨心力衰竭的相关危险因素和管理策略。回顾性分析了 2005 年至 2007 年期间接受左心瓣膜置换术的患者。记录主要不良心脏事件，包括死亡、住院、卒中和纽约心脏协会（NYHA）功能分类。通过比较术前、术后和随访的超声心动图图像来评估心脏重构。（1）.. 257 例接受左心二尖瓣、主动脉瓣或双瓣置换术的患者接受了 10.4±1.5 年的随访，全因死亡率为 18.7%，心力衰竭导致日常生活受限（NYHA III 或 IV）的发生率为 21.3%。（2）.. 与基线相比，经典心脏重构变量在长期随访中没有显著差异，例如左心室直径（47.9±8.3 vs 49.9±8.0mm， = .14）和左心室射血分数（58.6±9.6% vs 57.0±10.3%， = .34），但左心房前后径（LA）（39.7±9.5 vs 49.0±14.3mm， 〈 0.001）和三尖瓣反流（TR）（1.4±1.0 vs 2.2±1.2， 〈 0.001）有显著差异。多变量逻辑回归分析显示，LA≥50mm（ = .011）和中度以上三尖瓣反流（TR＞2）（ = .012）与心力衰竭长期预后不良相关。LA 和 TR 随术后时间的延长而进展。左心瓣膜置换术后 LA 扩大和 TR 是时间依赖性事件，代表心脏重构，与术后心力衰竭的长期后果密切相关。认识并探讨左心瓣膜置换术后患者不良心脏事件的长期预防和治疗策略非常重要。
