Sagie A, Freitas N, Padial L R, Leavitt M, Morris E, Weyman A E, Levine R A
Department of Medicine, Massachusetts General Hospital, Boston 02114, USA.
J Am Coll Cardiol. 1996 Aug;28(2):472-9. doi: 10.1016/0735-1097(96)00153-2.
The purpose of this study was to determine, in a large referral population, the rate of echocardiographic change in mitral valve area (MVA) without interim intervention, to determine which factors influence progression of narrowing and to examine associated changes in the right side of the heart.
Little information is currently available on the echocardiographic progression of mitral stenosis, particularly on progressive changes in the right side of the heart and the ability of a previously proposed algorithm to predict progression.
We studied 103 patients (mean age 61 years; 74% female) with serial two-dimensional and Doppler echocardiography. The average interval between entry and most recent follow-up study was 3.3 +/- 2 years (range 1 to 11).
During the follow-up period, MVA decreased at a mean rate of 0.09 cm2/year. In 28 patients there was no decrease, in 40 there was only relatively little change (< 0.1 cm2/year) and in 35 the rate of progression of mitral valve narrowing was more rapid (> or = 0.1 cm2/year). The rate of progression was significantly greater among patients with a larger initial MVA and milder mitral stenosis (0.12 vs. 0.06 vs. 0.03 cm2/year for mild, moderate and severe stenosis, p < 0.01). Although the rate of mitral valve narrowing was a weak function of initial MVA and echocardiographic score by multivariate analysis, no set of individual values or cutoff points of these variables or pressure gradients could predict this rate in individual patients. There was a significant increase in right ventricular diastolic area (17 to 18.7 cm2) and tricuspid regurgitation grade (2 + to 3 +; p < 0.0001 between entry and follow-up studies). Progression in right heart disease occurred even in patients with minimal or no change in MVA. Patients with associated aortic regurgitation had a higher rate of decrease in MVA than did those with trace or no aortic regurgitation (0.19 vs. 0.086 cm2/year, p < 0.05).
The rate of mitral valve narrowing in individual patients is variable and cannot be predicted by initial MVA, mitral valve score or transmitral gradient, alone or in combination. Right heart disease can progress independent of mitral valve narrowing.
本研究旨在确定在一大群转诊患者中，未经中间干预时二尖瓣口面积（MVA）的超声心动图变化率，确定哪些因素影响狭窄进展，并检查右心的相关变化。
目前关于二尖瓣狭窄的超声心动图进展，特别是右心的渐进性变化以及先前提出的预测进展的算法的能力，信息有限。
我们对103例患者（平均年龄61岁；74%为女性）进行了系列二维和多普勒超声心动图检查。入组至最近一次随访研究的平均间隔时间为3.3±2年（范围1至11年）。
在随访期间，MVA平均每年下降0.09 cm²。28例患者无下降，40例仅有相对较小的变化（<0.1 cm²/年），35例二尖瓣狭窄进展速度较快（≥0.1 cm²/年）。初始MVA较大且二尖瓣狭窄较轻的患者进展速度明显更快（轻度、中度和重度狭窄分别为0.12 vs. 0.06 vs. 0.03 cm²/年，p<0.01）。尽管通过多变量分析，二尖瓣狭窄的进展速度与初始MVA和超声心动图评分的关系较弱，但这些变量或压力梯度的任何一组个体值或临界值都无法预测个体患者的进展速度。右心室舒张面积（从17 cm²增加到18.7 cm²）和三尖瓣反流程度（从2+增加到3+；入组和随访研究之间p<0.0001）有显著增加。即使MVA变化最小或无变化的患者，右心疾病也会进展。合并主动脉反流的患者MVA下降率高于微量或无主动脉反流的患者（0.19 vs. 0.086 cm²/年，p<0.05）。
个体患者二尖瓣狭窄的进展速度是可变的，不能通过初始MVA、二尖瓣评分或跨二尖瓣梯度单独或联合预测。右心疾病可独立于二尖瓣狭窄而进展。
