Iung B, Cormier B, Ducimetière P, Porte J M, Nallet O, Michel P L, Acar J, Vahanian A
Cardiology Department, Tenon Hospital, Paris, France.
Circulation. 1996 Nov 1;94(9):2124-30. doi: 10.1161/01.cir.94.9.2124.
The wide use of percutaneous mitral commissurotomy (PMC) underlines the need to identify the predictive factors of the results. Using a large series allowed us to develop a multivariate model that can be applied to improve patient selection.
Between 1986 and 1995. PMC was undertaken in 1514 patients. Mean age was 45 +/- 15 years. Echocardiography showed that 245 patients (16%) had pliable valves and mild chordal thickening (group 1), 886 (59%) had extensive subvalvular disease (group 2), and 383 (25%) had calcified valves (group 3). PMC failed in 22 patients; it was performed with a single balloon in 30 patients, a double balloon in 586, and the Inoue balloon in 876. Good immediate results were defined as a valve area > or = 1.5 cm2 with mitral regurgitation Sellers' grade < or = 2 and were obtained in 1348 patients (89%). A logistic model developed from the first 1088 cases identified the following predictors of immediate results: age (P = .004), echocardiographic group (P < .0001), valve area (P < .0001), and effective balloon dilating area (EBDA) (P = .03). Two interactions were significant: age at previous commissurotomy (P = .013) and EBDA by initial mitral regurgitation (P = .034). The type of balloon was of borderline significance (P = .09). The model was validated on an independent sample comprising the subsequent 426 procedures. For a threshold of probability of good results of .75, sensitivity was 92%, specificity 25%, and predictive accuracy 87%.
Prediction of the immediate results of PMC is multifactorial. The predictive model developed and validated can be contributive in decision making for individual patients.
经皮二尖瓣交界切开术（PMC）的广泛应用凸显了识别结果预测因素的必要性。通过大量病例系列，我们得以建立一个多变量模型，该模型可用于改善患者选择。
1986年至1995年间，对1514例患者实施了PMC。平均年龄为45±15岁。超声心动图显示，245例患者（16%）瓣膜柔韧且腱索轻度增厚（第1组），886例（59%）有广泛的瓣下病变（第2组），383例（25%）有瓣膜钙化（第3组）。22例患者PMC失败；30例患者使用单个球囊进行操作，586例使用双球囊，876例使用Inoue球囊。良好的即刻结果定义为瓣膜面积≥1.5 cm²且二尖瓣反流Sellers分级≤2级，1348例患者（89%）获得该结果。从前1088例病例建立的逻辑模型确定了以下即刻结果的预测因素：年龄（P = .004）、超声心动图分组（P < .0001）、瓣膜面积（P < .0001）和有效球囊扩张面积（EBDA）（P = .03）。两个交互作用显著：既往交界切开术时的年龄（P = .013）和初始二尖瓣反流时的EBDA（P = .034）。球囊类型具有临界显著性（P = .09）。该模型在包含后续426例手术的独立样本上得到验证。对于良好结果概率阈值为.75时，敏感性为92%，特异性为25%，预测准确性为87%。
PMC即刻结果的预测是多因素的。所建立并验证的预测模型可有助于个体患者的决策制定。
