Sonaglioni Andrea, Nicolosi Gian Luigi, Rigamonti Elisabetta, Lombardo Michele
Department of Cardiology, Ospedale San Giuseppe Multi Medica IRCCS, Milan, Italy.
Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy.
J Cardiovasc Echogr. 2022 Jan-Mar;32(1):29-37. doi: 10.4103/jcecho.jcecho_71_21. Epub 2022 Apr 20.
The possible influence of chest wall conformation on cardiovascular (CV) outcome of patients with mitral regurgitation (MR) due to mitral valve prolapse (MVP) has never been previously investigated.
This retrospective study included all consecutive symptomatic patients with MVP and moderate MR who underwent exercise stress echocardiography at our institution between February 2014 and February 2021. Modified Haller Index (MHI; chest transverse diameter over the distance between sternum and spine) was noninvasively assessed. During the follow-up, we evaluated the occurrence of any of the following: (1) CV hospitalization, (2) mitral valve (MV) surgery, and (3) cardiac death or sudden death.
Four hundred and twenty-four consecutive patients (66.8 ± 11.5 years, 48.3% men) were retrospectively analyzed. Overall, MVP patients had concave-shaped chest wall (MHI = 2.55 ± 0.34) and were found with small cardiac chamber dimensions. During a mean follow-up time of 3.2 ± 1.7 years, no patients died, 55 patients were hospitalized due to CV events, and 20 patients underwent MV surgery. On multivariate Cox analysis, age (heart rate [HR] 1.05, 95% confidence interval [CI] 1.03-1.06), diabetes mellitus (HR 3.26, 95% CI 2.04-5.20), peak exercise-E/e' ratio (HR 1.07, 95%CI 1.05-1.09), and peak exercise-effective regurgitant orifice area (HR 2.53, 95% CI 1.83-3.51) were directly associated to outcome, whereas MHI (HR 0.15, 95%CI 0.07-0.33) and beta-blocker therapy (HR 0.26, 95% CI 0.19-0.36) showed strong inverse correlation. An MHI ≥2.7 showed 80% sensitivity and 100% specificity for predicting event-free survival (area under the curve = 0.98).
Symptomatic patients with moderate MR due to MVP and MHI ≥2.7 have an excellent prognosis over a medium-term follow-up. Noninvasive chest wall shape assessment should be encouraged in clinical practice.
胸壁形态对二尖瓣脱垂（MVP）所致二尖瓣反流（MR）患者心血管（CV）结局的潜在影响此前从未被研究过。
这项回顾性研究纳入了2014年2月至2021年2月期间在我院接受运动负荷超声心动图检查的所有连续性有症状的MVP和中度MR患者。采用改良哈勒指数（MHI；胸廓横径与胸骨和脊柱之间距离的比值）进行无创评估。在随访期间，我们评估了以下任何一种情况的发生：（1）心血管住院，（2）二尖瓣（MV）手术，以及（3）心源性死亡或猝死。
对424例连续性患者（66.8±11.5岁，男性占48.3%）进行了回顾性分析。总体而言，MVP患者胸壁呈凹形（MHI = 2.55±0.34），且心脏腔室尺寸较小。在平均3.2±1.7年的随访期内，无患者死亡，55例患者因心血管事件住院，20例患者接受了MV手术。多因素Cox分析显示，年龄（心率[HR]1.05，95%置信区间[CI]1.03 - 1.06）、糖尿病（HR 3.26，95%CI 2.04 - 5.20）、运动峰值E/e'比值（HR 1.07，95%CI 1.05 - 1.09）和运动峰值有效反流口面积（HR 2.53，95%CI 1.83 - 3.51）与结局直接相关，而MHI（HR 0.15，95%CI 0.07 - 0.33）和β受体阻滞剂治疗（HR 0.26，95%CI 0.19 - 0.36）显示出强烈的负相关。MHI≥2.7对预测无事件生存的敏感性为80%，特异性为100%（曲线下面积 = 0.98）。
有症状的MVP所致中度MR且MHI≥2.7的患者在中期随访中有良好的预后。临床实践中应鼓励进行无创胸壁形态评估。
