Uretsky Seth, Igancio Jonathan, Vegh Andrea, Maher Thomas, Animashaun Islamiyat Babs, Horgan Stephen J, Okunade Adeniyi, Schaikewitz Matthew F, Hsieh Eric, Rutledge John R, Wolff Steven D
Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, 100 Madison Ave, Morristown, NJ, 07960, USA.
Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's Hospital, Mount Sinai School of Medicine, New York, NY, USA.
Int J Cardiovasc Imaging. 2025 Feb;41(2):291-301. doi: 10.1007/s10554-024-03308-3. Epub 2024 Dec 30.
In the ACC/AHA guidelines, the presence of symptoms plays a central role in determining timing surgery in primary mitral regurgitation (MR). Studies have shown a disconnect between the severity of MR and symptoms. The purpose of this study is to assess risk factors for symptoms in patients with chronic primary MR. There were 430 patients with degenerative MR and preserved left ventricular function who underwent cardiovascular magnetic resonance (CMR). MR volume (MRV) and MR fraction (MRF) were categorized as per the ACC/AHA guidelines. Patients were divided into three groups based on category of MRV and MRF: (1) MRV category > MRF category (V > F), (2) MRV = MRF category (V = F), and (3) MRV < MRF category (V < F). Symptoms were defined as shortness of breath, fatigue, and decreased exercise capacity and extracted from chart review. There were 134 (38%) patients who reported symptoms. Based on MRV, 236 (55%), 125 (29%), and 69 (16%) patients had mild moderate, and severe MR respectively. Based on MRF, 257 (60%), 130 (30%), and 43 (10%) patients had mild moderate, and severe MR respectively. There was no increase in the prevalence of symptoms with worsening MRV severity (39%, 40% and 30% for mild, moderate and severe MRV respectively, p = 0.4). There was a trend for increase in the prevalence of symptoms in patients with severe MRF (35%, 40% and 54% for mild, moderate and severe MRF respectively, p = 0.054). There was a significant increase in the prevalence of symptoms when comparing V > F, V = F, and V < F (20%, 40%, and 72% respectively, p < 0.0001). On multivariable analysis, risk factors for symptoms were age, female sex, MRF, and having a V < F. In patients undergoing CMR with degenerative MR the prevalence of symptoms do not increase with worsening MRV. MRV and MRF were not risk factors for symptoms but having V < F was a risk factors for the presence of symptoms. These findings suggest that symptomatic patients with MR may have other pathology which may be responsible for their symptoms. Further studies are needed to better characterize the relationship between MR severity and symptoms.
在ACC/AHA指南中，症状的存在在决定原发性二尖瓣反流（MR）手术时机方面起着核心作用。研究表明，MR的严重程度与症状之间存在脱节。本研究的目的是评估慢性原发性MR患者出现症状的危险因素。有430例退行性MR且左心室功能保留的患者接受了心血管磁共振（CMR）检查。根据ACC/AHA指南对MR容积（MRV）和MR分数（MRF）进行分类。根据MRV和MRF的类别将患者分为三组：（1）MRV类别＞MRF类别（V＞F），（2）MRV = MRF类别（V = F），以及（3）MRV＜MRF类别（V＜F）。症状定义为呼吸急促、疲劳和运动能力下降，并通过病历审查提取。有134例（38%）患者报告有症状。根据MRV，分别有236例（55%）、125例（29%）和69例（16%）患者患有轻度、中度和重度MR。根据MRF，分别有257例（60%）、130例（30%）和43例（10%）患者患有轻度、中度和重度MR。症状的患病率并未随着MRV严重程度的加重而增加（轻度、中度和重度MRV分别为39%、40%和30%，p = 0.4）。重度MRF患者的症状患病率有增加趋势（轻度、中度和重度MRF分别为35%、40%和54%，p = 0.054）。比较V＞F、V = F和V＜F时，症状的患病率显著增加（分别为20%、40%和72%，p＜0.0001）。多变量分析显示，症状的危险因素为年龄、女性、MRF以及V＜F。在接受CMR检查的退行性MR患者中，症状的患病率不会随着MRV的加重而增加。MRV和MRF不是症状的危险因素，但V＜F是出现症状的危险因素。这些发现表明有症状的MR患者可能有其他病理情况导致其症状。需要进一步研究以更好地描述MR严重程度与症状之间的关系。
