Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy.
Fondazione Toscana G. Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
J Cardiol. 2022 Jan;79(1):90-97. doi: 10.1016/j.jjcc.2021.08.014. Epub 2021 Sep 6.
We aimed to determine predictors and the additive prognostic role of moderate to severe (MS) ischemic mitral regurgitation (MR) in myocardial infarction (MI).
Four hundred twenty-two patients with previous MI underwent cardiac magnetic resonance (CMR) imaging for the assessment of left ventricular (LV) ejection fraction (EF), end-diastolic (EDV) and end-systolic volume (ESV), sphericity index, wall motion score index (WMSI), and late gadolinium enhancement (LGE). Echocardiography was performed to assess MR.
Thirty-eight had from moderate to severe MR (MS-MR group) and 384 did not (No MS-MR group). The S-MR group had higher LV volumes, sphericity index, WMSI, and LGE extent, and lower LVEF. At univariate logistic regression analysis, dilated volumes, SI >0.43, dyskinesia of inferolateral wall, papillary muscle (PM)-LGE, and LGE extent >16% were associated with MS-MR. At multivariate analysis, only SI (OR=5.7) and PM-LGE (OR=3) were independently associated with MS-MR. Considering only patients without LV dilatation, only dyskinesia in the inferolateral wall was a predictor of MS-MR (OR 34.8). Thirty cardiac events (cardiac death, appropriate implantable cardioverter-defibrillator firing, and resuscitated cardiac arrest) occurred during a median follow-up of 1,276 days. After adjusting the prognostic variables at univariate analysis by age (>65 years) and selecting those that were significant (EDV > 95 ml/m, ESV >53 ml/m, EF <30%, WMSI >1.65, LGE >12%, S-MR), only WMSI >1.65 and MS-MR remained an independent predictor of cardiac events.
Increased WMSI and PM-LGE in the overall population and inferolateral dyskinesia in patients without ESV dilatation are predictors of MS-MR; MS-MR and elevated WMSI have independent negative prognostic value.
本研究旨在确定中度至重度（MS）缺血性二尖瓣反流（MR）在心肌梗死（MI）中的预测因素及其附加预后价值。
422 例既往有 MI 的患者接受心脏磁共振（CMR）成像评估左心室（LV）射血分数（EF）、舒张末期（EDV）和收缩末期容积（ESV）、球形指数、壁运动评分指数（WMSI）和晚期钆增强（LGE）。行超声心动图评估 MR。
38 例患者存在中度至重度 MR（MS-MR 组），384 例患者不存在（无 MS-MR 组）。S-MR 组的 LV 容积、球形指数、WMSI 和 LGE 范围更大，而 LVEF 更低。在单变量逻辑回归分析中，扩张的容积、SI＞0.43、下外侧壁运动障碍、乳头肌（PM）-LGE 和 LGE 范围＞16%与 MS-MR 相关。多变量分析中，仅 SI（OR=5.7）和 PM-LGE（OR=3）与 MS-MR 独立相关。仅考虑 LV 不扩张的患者，仅下外侧壁运动障碍是 MS-MR 的预测因素（OR 34.8）。30 例心脏不良事件（心脏性死亡、适当植入式心律转复除颤器放电和复苏性心脏骤停）在中位随访 1276 天期间发生。在单变量分析中调整预后变量（年龄＞65 岁）并选择有意义的变量（EDV＞95ml/m，ESV＞53ml/m，EF＜30%，WMSI＞1.65，LGE＞12%，S-MR）后，仅 WMSI＞1.65 和 MS-MR 仍然是心脏不良事件的独立预测因素。
整体人群中 WMSI 增加和 PM-LGE 以及 ESV 不扩张患者中的下外侧壁运动障碍是 MS-MR 的预测因素；MS-MR 和升高的 WMSI 具有独立的负预后价值。
