Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, 100 Madison Ave, Morristown, NJ, 07960, USA.
Department of Medicine, Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai School of Medicine, New York, NY, USA.
Int J Cardiovasc Imaging. 2023 Sep;39(9):1677-1685. doi: 10.1007/s10554-023-02881-3. Epub 2023 Jun 22.
Although it is assumed that more severe MR is associated with a greater burden of symptoms and lower exercise capacity, the relationship between symptoms, exercise capacity, and mitral regurgitant severity has not been well studied. We prospectively studied 67 (63 ± 11 years, 72% male) patients with at least mild degenerative MR and left ventricular ejection fraction ≥ 50% who underwent stress echocardiography, CMR, and evaluation with the Kansas City Cardiomyopathy questionnaire (KCCQ). Symptoms and exercise capacity were evaluated in the context of MR severity. Patients reporting dyspnea had lower KCCQ symptom scores (79 ± 23 vs. 96 ± 9, p = 0.01) and achieved lower percentage of age and gender predicted METs (114 ± 37 vs. 152 ± 43%, p < 0.001) compared to those without dyspnea. There was no significant difference in MR volume between those with vs. without dyspnea by CMR (43 ± 26 ml vs. 51 ± 28 ml, p = 0.3) or echocardiography (64 ± 28 vs. 73 ± 41ml, p = 0.4). Those with severe MR by CMR had similar KCCQ symptom scores (96 ± 10 vs. 89 ± 17, p = 0.04) and percentage of age and gender predicted METs (148 ± 42 vs. 133 ± 47%, p = 0.2) to those without severe MR. Those with severe MR by echocardiography had similar KCCQ symptom score (93 ± 15 vs. 89 ± 16, p = 0.3) and percentage of age and gender predicted METs (138 ± 43 vs. 153 ± 46%, p = 0.2) to those without severe MR. Patients with degenerative MR assessed by CMR and stress echocardiography, there was no relationship between MR severity and either symptoms or exercise capacity. These findings highlight the disconnect between symptoms and the severity of MR and challenge the assumption that correcting MR can be counted on to improve symptom status in patients with degenerative MR.
尽管人们认为更严重的二尖瓣反流（MR）与更多的症状负担和更低的运动能力相关，但症状、运动能力和二尖瓣反流严重程度之间的关系尚未得到很好的研究。我们前瞻性地研究了 67 名（63±11 岁，72%为男性）至少患有轻度退行性 MR 和左心室射血分数≥50%的患者，他们接受了应激超声心动图、心脏磁共振（CMR）和堪萨斯城心肌病问卷（KCCQ）评估。在二尖瓣反流严重程度的背景下评估了症状和运动能力。报告呼吸困难的患者 KCCQ 症状评分较低（79±23 与 96±9，p=0.01），达到的年龄和性别预测代谢当量百分比较低（114±37 与 152±43%，p<0.001）与无呼吸困难的患者相比。CMR（43±26 毫升与 51±28 毫升，p=0.3）或超声心动图（64±28 与 73±41 毫升，p=0.4）显示有呼吸困难和无呼吸困难的患者之间的 MR 容积无显著差异。CMR 严重 MR 的患者的 KCCQ 症状评分相似（96±10 与 89±17，p=0.04）和年龄和性别预测代谢当量百分比（148±42 与 133±47%，p=0.2）与无严重 MR 的患者相似。超声心动图严重 MR 的患者的 KCCQ 症状评分相似（93±15 与 89±16，p=0.3）和年龄和性别预测代谢当量百分比（138±43 与 153±46%，p=0.2）与无严重 MR 的患者相似。通过 CMR 和应激超声心动图评估退行性 MR 的患者，MR 严重程度与症状或运动能力之间没有关系。这些发现强调了症状和 MR 严重程度之间的脱节，并挑战了纠正 MR 可以改善退行性 MR 患者症状状态的假设。
