Qiao Linfang, Huang Haozhang, Liu Jiulin, Jia Congzhuo, He Yibo, Yu Sijia, Lu Hongyu, Zhou Ziyou, Chang Tian, Chen Shiqun, Tan Ning, Liu Jin, Liu Yong, Chen Jiyan
The Second School of Clinical Medicine, Southern Medical University, 510515 Guangzhou, Guangdong, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2023 Sep 18;24(9):256. doi: 10.31083/j.rcm2409256. eCollection 2023 Sep.
Patients with secondary mitral regurgitation (sMR) often present with greater mortality and comorbidity, which may be predicted by some risk factors. This study was designed to investigate the prognostic meaning of the echocardiographically detected wall motion score index (WMSI) in coronary artery disease (CAD) patients with moderate or severe baseline sMR who underwent percutaneous coronary intervention (PCI) therapy.
The present study was a multi-center and prospective cohort of consecutive CAD patients with baseline moderate or severe sMR who underwent PCI. All underwent echocardiography at baseline and at follow-up after PCI to assess sMR and WMSI. The primary endpoint was the persistence of moderate or severe sMR after the second echocardiographic measurement. Logistic and Cox proportional hazards models were constructed for the primary (persistent moderate or severe sMR) and secondary (worsening heart failure [HF]; all-cause mortality; cardiovascular-specific mortality; and major adverse cardiovascular events [MACE]) endpoints.
Among 920 participants, 483 had WMSI values of 1.47, and 437 were less. Of all the participants, 366 (39.8%) continued to have moderate or severe sMR after the second echocardiogram measurement. After full adjustment for confounders, elevated WMSI after PCI was independently associated with the primary endpoint during 3-12 month follow-up. Similarly, elevated WMSI was associated with increased risk of worsening HF, all-cause mortality, cardiovascular-specific mortality, and MACE.
Persistent moderate or severe sMR is common (approximately 40%) in PCI patients. Elevated WMSI in CAD patients after PCI is a predictor of persistent moderate or severe sMR and has independent negative prognostic value. Patients with CAD and sMR should be monitored for WMSI to identify those at higher risk of mortality and comorbidity.
继发性二尖瓣反流（sMR）患者的死亡率和合并症往往更高，某些风险因素可能对其具有预测作用。本研究旨在调查经超声心动图检测的壁运动评分指数（WMSI）在接受经皮冠状动脉介入治疗（PCI）的中度或重度基线sMR冠心病（CAD）患者中的预后意义。
本研究是一项多中心前瞻性队列研究，纳入连续的接受PCI治疗的基线中度或重度sMR的CAD患者。所有患者在基线时以及PCI术后随访时均接受超声心动图检查，以评估sMR和WMSI。主要终点是第二次超声心动图测量后持续存在中度或重度sMR。构建逻辑回归和Cox比例风险模型用于主要终点（持续存在中度或重度sMR）和次要终点（心力衰竭[HF]恶化；全因死亡率；心血管特异性死亡率；以及主要不良心血管事件[MACE]）。
在920名参与者中，483人的WMSI值为1.47，437人低于该值。在所有参与者中，366人（39.8%）在第二次超声心动图测量后仍存在中度或重度sMR。在对混杂因素进行充分调整后，PCI术后WMSI升高与3至12个月随访期间的主要终点独立相关。同样，WMSI升高与HF恶化、全因死亡率、心血管特异性死亡率和MACE风险增加相关。
PCI患者中持续存在中度或重度sMR很常见（约40%）。CAD患者PCI术后WMSI升高是持续存在中度或重度sMR的预测指标，具有独立的不良预后价值。应对CAD和sMR患者监测WMSI，以识别死亡和合并症风险较高的患者。
