心力衰竭中二尖瓣反流的患病率及特征：一项图表回顾研究
The Prevalence and Characteristics of Mitral Regurgitation in Heart Failure: A Chart Review Study.
作者信息
Zhao Chengchen, Jin Chunna, Shen Yimin, Lin Xiaoping, Yu Yi, Xiang Meixiang
机构信息
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Key Lab of Cardiovascular Disease of Zhejiang Province, 310009 Hangzhou, Zhejiang, China.
出版信息
Rev Cardiovasc Med. 2022 Jun 24;23(7):235. doi: 10.31083/j.rcm2307235. eCollection 2022 Jul.
BACKGROUND
Mitral regurgitation (MR) is one of the common complications of heart failure (HF). The prevalence and characteristics of MR are rarely investigated, especially in the Chinese population.
OBJECTIVES
The purpose of this study was to determine the prevalence and characteristics of non-organic MR in HF patients and subgroups defined by ejection fraction.
METHODS
A single-center, hospital-based, and retrospective chart review study included patients with heart failure admitted to the cardiovascular department from January 2017 to April 2020. Demographic characteristics, laboratory results, and echocardiogram results before discharge were analyzed in different groups defined by left ventricular ejection fraction (EF) using logistic regression and adjusted for confounders.
RESULTS
Finally, 2418 validated HF patients (age 67.2 13.5 years; 68.03% men) were included. The prevalence of MR was 32.7% in HF, 16.7% in HF with preserve EF patients, 28.4% in HF with mid-range EF patients and 49.7% in HF with reduced EF (HFrEF) patients. In the HF with preserved EF group, multivariable logistic regression showed that 4 factors associated with MR including EF (odds ratio (OR) 0.954 (0.928-0.981), = 0.001), left ventricular posterior wall thickness in diastolic phase (LVPWd) (OR 0.274 (0.081-0.932), = 0.038), left atrium (LA) dimension (OR 2.049 (1.631-2.576), 0.001) and age (OR 1.024 (1.007-1.041), = 0.007). In the HF with midrange EF group, multivariable logistic regression showed that 3 factors associated with MR including LA dimension (OR 2.009 (1.427-2.829), 0.001), triglycerides (TG) (OR 0.552 (0.359-0.849), = 0.007) and digoxin (OR 2.836 (1.624-4.951), 0.001). In the HFrEF group, multivariable logistic regression showed that 7 factors associated with MR including EF (OR 0.969 (0.949-0.990), = 0.004), (OR 0.161 (0.067-0.387), 0.001), LA dimension (OR 2.289 (1.821-2.878), 0.001), age (OR 1.016 (1.004-1.027)), = 0.009), TG (OR 0.746 (0.595-0.936), = 0.011), diuretics (OR 0.559 (0.334-0.934), = 0.026) and ICD (OR 1.898 (1.074-3.354), = 0.027).
CONCLUSIONS
HF patients had a high burden of MR, particularly in the HFrEF group. Worsen cardiac structure (LA dimension and LVPWd) and function (EF), age, and medical treatment strategy played essential roles in MR.
背景
二尖瓣反流（MR）是心力衰竭（HF）的常见并发症之一。MR的患病率及特征鲜少被研究，尤其是在中国人群中。
目的
本研究旨在确定HF患者及按射血分数定义的亚组中非器质性MR的患病率及特征。
方法
一项基于医院的单中心回顾性病历审查研究纳入了2017年1月至2020年4月心血管科收治的心力衰竭患者。使用逻辑回归分析不同左心室射血分数（EF）定义组的人口统计学特征、实验室检查结果及出院前超声心动图结果，并对混杂因素进行校正。
结果
最终纳入2418例确诊的HF患者（年龄67.2±13.5岁；男性占68.03%）。HF患者中MR的患病率为32.7%，射血分数保留的HF患者中为16.7%，射血分数中等范围的HF患者中为28.4%，射血分数降低的HF（HFrEF）患者中为49.7%。在射血分数保留的HF组中，多变量逻辑回归显示与MR相关的4个因素包括EF（比值比（OR）0.954（0.928 - 0.981），P = 0.001）、舒张期左心室后壁厚度（LVPWd）（OR 0.274（0.081 - 0.932），P = 0.038）、左心房（LA）内径（OR 2.049（1.631 - 2.576），P < 0.001）和年龄（OR 1.024（1.007 - 1.041），P = 0.007）。在射血分数中等范围的HF组中，多变量逻辑回归显示与MR相关的3个因素包括LA内径（OR 2.009（1.427 - 2.829），P < 0.001）、甘油三酯（TG）（OR 0.552（0.359 - 0.849），P = 0.007）和地高辛（OR 2.836（1.624 - 4.951），P < 0.001）。在HFrEF组中，多变量逻辑回归显示与MR相关的7个因素包括EF（OR 0.969（0.949 - 0.990），P = 0.004）、（此处原文缺失一个变量）（OR 0.161（0.067 - 0.387），P < 0.001）、LA内径（OR 2.289（1.821 - 2.878），P < 0.001）、年龄（OR 1.016（1.004 - 1.027），P = 0.009）、TG（OR 0.746（0.595 - 0.936），P = 0.011）、利尿剂（OR 0.559（0.334 - 0.934），P = 0.026）和植入式心律转复除颤器（ICD）（OR 1.898（1.074 - 3.354），P = 0.027）。
结论
HF患者MR负担较重，尤其是在HFrEF组。心脏结构（LA内径和LVPWd）和功能（EF）恶化、年龄及治疗策略在MR中起重要作用。
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