Kim S, Kuroda T, Nishinaga M, Yamasawa M, Watanabe S, Mitsuhashi T, Ueda S, Shimada K
Department of Cardiology, Jichi Medical School, Tochigi, Japan.
Am Heart J. 1996 Aug;132(2 Pt 1):348-55. doi: 10.1016/s0002-8703(96)90432-9.
We investigated the relation between the severity of mitral regurgitation and the development of complications and cardiac events by using two-dimensional and color Doppler echocardiography in 229 consecutive patients with mitral valve prolapse. The frequency of moderate and severe mitral regurgitation was significantly higher in patients with a prolapsed posterior leaflet (61%) than in patients with a prolapsed anterior leaflet (25%), and the older the patient, the greater the severity of mitral regurgitation. The occurrence of complications, such as atrial fibrillation, congestive heart failure, and chordal rupture, was significantly greater in prolapsed posterior leaflet cases than in prolapsed anterior leaflet cases, and the occurrence was closely associated with the degree of severity of mitral regurgitation. Multiple logistic regression analysis showed that the severity of mitral regurgitation is a strong prognostic indicator for developing complications. Furthermore in a subgroup of 49 patients tracked for a mean of 4.8 years, the new development of complications was significantly higher in patients who showed a progression in the severity of mitral regurgitation (52%) that in patients without progression in severity (8%). The initial severity of mitral regurgitation was related to the occurrence of cardiac events (mitral valve replacement, infective endocarditis, cerebral embolism and death). The data indicated that the progression of mitral regurgitation is closely associated with the development of complications and cardiac events and suggest that the severity of mitral regurgitation is an important prognostic indicator for the development of complications and cardiac events in patients with mitral valve prolapse.
我们采用二维和彩色多普勒超声心动图，对229例连续性二尖瓣脱垂患者二尖瓣反流的严重程度与并发症及心脏事件的发生之间的关系进行了研究。后叶脱垂患者中、重度二尖瓣反流的发生率（61%）显著高于前叶脱垂患者（25%），且患者年龄越大，二尖瓣反流越严重。房颤、充血性心力衰竭和腱索断裂等并发症的发生率，后叶脱垂病例显著高于前叶脱垂病例，且其发生与二尖瓣反流的严重程度密切相关。多因素logistic回归分析显示，二尖瓣反流的严重程度是发生并发症的一个强有力的预后指标。此外，在平均随访4.8年的49例患者亚组中，二尖瓣反流严重程度进展的患者并发症的新发生率（52%）显著高于严重程度无进展的患者（8%）。二尖瓣反流的初始严重程度与心脏事件（二尖瓣置换、感染性心内膜炎、脑栓塞和死亡）的发生有关。数据表明，二尖瓣反流的进展与并发症和心脏事件的发生密切相关，提示二尖瓣反流的严重程度是二尖瓣脱垂患者发生并发症和心脏事件的一个重要预后指标。
