Heart Valve Clinic & Echocardiography Laboratory, Barts Heart Centre; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom; Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia.
Heart Valve Clinic & Echocardiography Laboratory, Barts Heart Centre; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, London, United Kingdom.
Am J Cardiol. 2023 Aug 15;201:8-15. doi: 10.1016/j.amjcard.2023.05.039. Epub 2023 Jun 20.
The current guidelines recommend intervention in severe degenerative mitral regurgitation (MR) in symptomatic patients or asymptomatic patients with left ventricular dilatation or dysfunction. The insidious onset of symptoms may mean that patients do not report their symptoms. The role of systematic exercise testing for symptoms in MR is not clearly defined. A total of 97 patients with moderate to severe asymptomatic MR underwent exercise echocardiography combined with cardiopulmonary exercise testing. The predictors of exercise-induced dyspnea, symptom-free survival, and mitral valve intervention were identified. A total of 18 patients (19%) developed limiting dyspnea on exercise. Spontaneous symptom-free survival at 24 months was significantly higher in those without exercise-induced symptoms than those with exercise-induced symptoms, p <0.0001. The only independent predictors of spontaneous symptoms at 2 years were effective regurgitant orifice area (odds ratio 27.45, 95% confidence interval [CI] 1.43 to 528.40, p = 0.03) and exercise-induced symptoms (odds ratio 11.56, 95% CI 1.71 to 78.09, p = 0.01). The only independent predictor of surgery was indexed left ventricular systolic volumes (odds ratio 1.17, 95% CI 1.04 to 1.30, p = 0.006). Where only the patients who underwent surgery due to symptoms were included, the only independent predictor was exercise-induced symptoms (odds ratio 13.94, 95% CI 1.39 to 140.27, p = 0.025). In conclusion, in patients with primary asymptomatic degenerative MR, 1/5 develop revealed symptoms during exercise. This predicts a subsequent development of spontaneous symptoms and mitral valve intervention due to symptoms.
目前的指南建议对有症状的严重退行性二尖瓣反流（MR）患者或有左心室扩张或功能障碍的无症状患者进行干预。症状的隐匿性发作可能意味着患者没有报告他们的症状。MR 患者症状的系统运动测试的作用尚未明确界定。共有 97 名中重度无症状退行性 MR 患者接受了运动超声心动图结合心肺运动测试。确定了运动诱发呼吸困难、无症状生存和二尖瓣瓣膜干预的预测因子。共有 18 名（19%）患者在运动时出现限制型呼吸困难。无运动诱导症状患者的 24 个月无症状生存显著高于有运动诱导症状患者，p<0.0001。2 年内自发性症状的唯一独立预测因子是有效反流口面积（优势比 27.45，95%置信区间 [CI] 1.43 至 528.40，p=0.03）和运动诱导症状（优势比 11.56，95%CI 1.71 至 78.09，p=0.01）。手术的唯一独立预测因子是左心室收缩容积指数（优势比 1.17，95%CI 1.04 至 1.30，p=0.006）。仅包括因症状而接受手术的患者，唯一的独立预测因子是运动诱导的症状（优势比 13.94，95%CI 1.39 至 140.27，p=0.025）。总之，在原发性无症状退行性 MR 患者中，1/5 在运动时出现了明显的症状。这预示着随后会出现自发性症状和因症状而进行二尖瓣瓣膜干预。
