Enriquez-Sarano M, Tajik A J, Schaff H V, Orszulak T A, McGoon M D, Bailey K R, Frye R L
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1994 Nov 15;24(6):1536-43. doi: 10.1016/0735-1097(94)90151-1.
This study attempted to determine the incidence, prognosis and predictability of postoperative left ventricular dysfunction in patients undergoing correction of mitral regurgitation.
Left ventricular function in patients with mitral regurgitation is altered by loading conditions and is difficult to assess. Predictive value of preoperative variables on postoperative left ventricular function and the role of echocardiography are uncertain.
In 266 patients undergoing correction of mitral regurgitation between 1980 and 1989, left ventricular function was echocardiographically assessed preoperatively (within 6 months) and postoperatively (within 1 year).
After correction of mitral regurgitation, left ventricular ejection fraction decreased significantly ([mean +/- SD] 50% +/- 14% vs. 58% +/- 13%, p < 0.0001). Postoperative left ventricular dysfunction (ejection fraction < 50%) was frequent (41% of patients) and carried a poor prognosis (at 8 years survival, 38% +/- 9% vs. 69% +/- 8%, p < 0.0001). Four preoperative echocardiographic variables showed good correlation with postoperative ejection fraction: preoperative ejection fraction (r = -0.70), systolic diameter (r = -0.63), diameter/thickness ratio (r = -0.64) and end-systolic wall stress (r = -0.62) (all p < 0.0001). With multivariate analysis, ejection fraction (p = 0.0001) and systolic diameter (p = 0.0005) were independent predictors of postoperative ejection fraction, and angiographic variables provided no incremental predictive power. In addition to echocardiographic variables, recent regurgitation, functional class and coronary artery disease were also independent predictors of postoperative ejection fraction.
After surgical correction of mitral regurgitation, left ventricular dysfunction is frequent and carries a poor prognosis. Postoperative ejection fraction can be predicted by echocardiographic preoperative ejection fraction and systolic diameter. Recent onset of regurgitation, mild or no symptoms, and absence of coronary artery disease are independent and favorable predictors of postoperative ejection fraction. These results should lead to consideration of surgical correction at an earlier stage.
本研究旨在确定二尖瓣反流矫正患者术后左心室功能障碍的发生率、预后及可预测性。
二尖瓣反流患者的左心室功能会因负荷情况而改变，且难以评估。术前变量对术后左心室功能的预测价值以及超声心动图的作用尚不确定。
在1980年至1989年间接受二尖瓣反流矫正的266例患者中，术前（6个月内）和术后（1年内）通过超声心动图评估左心室功能。
二尖瓣反流矫正后，左心室射血分数显著降低（[均值±标准差]50%±14%对58%±13%，p<0.0001）。术后左心室功能障碍（射血分数<50%）很常见（41%的患者），且预后较差（8年生存率，38%±9%对69%±8%，p<0.0001）。四个术前超声心动图变量与术后射血分数显示出良好的相关性：术前射血分数（r=-0.70）、收缩期直径（r=-0.63）、直径/厚度比（r=-0.64）和收缩末期壁应力（r=-0.62）（均p<0.0001）。通过多变量分析，射血分数（p=0.0001）和收缩期直径（p=0.0005）是术后射血分数的独立预测因素，血管造影变量未提供额外的预测能力。除超声心动图变量外，近期反流情况、心功能分级和冠状动脉疾病也是术后射血分数的独立预测因素。
二尖瓣反流手术矫正后，左心室功能障碍很常见且预后较差。术后射血分数可通过术前超声心动图射血分数和收缩期直径进行预测。近期发生反流、轻度或无症状以及无冠状动脉疾病是术后射血分数的独立且有利的预测因素。这些结果应促使在更早阶段考虑手术矫正。
