Piatkowski Radoslaw, Kochanowski Janusz, Budnik Monika, Peller Michal, Grabowski Marcin, Opolski Grzegorz
1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.
J Clin Med. 2021 Oct 20;10(21):4816. doi: 10.3390/jcm10214816.
Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone.
A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; = 90) or CABGmp (gr.2; = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery.
Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; = 0.742).
The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.
尽管单纯冠状动脉旁路移植术（CABGa）或联合二尖瓣成形术（CABGmp）被认为是缺血性二尖瓣反流（IMR）患者的最佳治疗策略，但仍有一些复发情况被报道。本研究的目的是评估二尖瓣变形指数（MDI）作为单纯CABG术后12个月二尖瓣反流复发预测指标的应用价值。
本研究前瞻性纳入了145例心肌梗死后合并严重IMR且适合CABG的患者。术前评估二尖瓣形态、左心室功能、通过有效反流口面积（ERO）评估的IMR程度、心肌活力和MDI。根据临床评估以及静息和负荷超声心动图（运动超声心动图和低剂量多巴酚丁胺超声心动图-DBX）结果，将患者分为CABGa组（第1组；n = 90）或CABGmp组（第2组；n = 55）。术后1年，对每位患者进行心血管事件评估。采用单因素逻辑回归分析确定1年随访中IMR复发的因素。所有患者在出院时、术后1个月和12个月进行系列超声心动图检查。
逻辑回归分析显示，在CABGa组中，DBX期间术前帐篷面积（TA）和瓣叶对合高度（CH）的变化仍是12个月随访中IMR复发的预测指标。TAdbx>1 cm时，敏感性为90%，特异性为29%（AUC 0.6436）。CHdbx的最佳截断值为0.4 cm（敏感性90%，特异性34%；AUC 0.6432）。两组（CABGa组与CABGmp组）在12个月死亡率（1.2%对0%；P = 1.0）、因心力衰竭（HF）加重导致的住院率（5.9%对8.5%；P = 0.72）以及复合终点（死亡/CV住院/卒中）发生率（7%对8.5%；P = 0.742）方面均未观察到显著差异。
DBX期间MDI变化的术前评估可用于识别单纯CABG的IMR患者，这些患者在1年随访中有较高的IMR复发风险。二尖瓣变形分析应用于更好地评估IMR患者以确定确切的手术方式。
