Nishimura R A, McGoon M D, Shub C, Miller F A, Ilstrup D M, Tajik A J
N Engl J Med. 1985 Nov 21;313(21):1305-9. doi: 10.1056/NEJM198511213132101.
We determined the long-term prognosis for patients with mitral-valve prolapse documented by echocardiography by following 237 minimally symptomatic or asymptomatic patients for a mean of 6.2 years (range, 1 to 10.4). The actuarial eight-year probability of survival was 88 per cent, which is not significantly different from that for a matched control population. An initial left ventricular diastolic dimension exceeding 60 mm was the best echocardiographic predictor of the subsequent need for mitral-valve replacement (17 patients). Of the 97 patients with redundant mitral-valve leaflets identified echocardiographically, 10 (10.3 per cent) had sudden death, infective endocarditis, or a cerebral embolic event; in contrast, of the 140 patients with nonredundant valves, only 1 (0.7 per cent) had such complications (P less than 0.001). Most patients with echocardiographic evidence of mitral-valve prolapse have a benign course, but subsets at high risk for the development of progressive mitral regurgitation, sudden death, cerebral embolic events, or infective endocarditis can be identified by echocardiography.
我们通过对237例症状轻微或无症状的患者进行平均6.2年（范围1至10.4年）的随访，确定了经超声心动图证实的二尖瓣脱垂患者的长期预后。精算得出的八年生存率为88%，与匹配的对照人群相比无显著差异。最初左心室舒张内径超过60 mm是超声心动图预测随后需要进行二尖瓣置换术（17例患者）的最佳指标。在经超声心动图检查发现二尖瓣叶冗长的97例患者中，10例（10.3%）发生了猝死、感染性心内膜炎或脑栓塞事件；相比之下，在140例瓣膜无冗长表现的患者中，只有1例（0.7%）发生了此类并发症（P<0.001）。大多数有超声心动图证据显示二尖瓣脱垂的患者病程呈良性，但通过超声心动图可以识别出有发生进行性二尖瓣反流、猝死、脑栓塞事件或感染性心内膜炎高风险的亚组。
