Pozzoli M, Traversi E, Cioffi G, Stenner R, Sanarico M, Tavazzi L
Salvatore Maugeri Foundation, IRCCS, Montescano Medical Center, Pavia, Italy.
Circulation. 1997 Mar 4;95(5):1222-30. doi: 10.1161/01.cir.95.5.1222.
Mitral flow velocity patterns (MFVPs) evaluated by Doppler echocardiography are strong predictors of survival in various cardiac diseases. However, MFVPs may change over time according to loading conditions. We performed this prospective study to assess whether changes in MFVP induced by loading manipulations provided additional prognostic information in 173 patients with chronic heart failure.
Simultaneous Doppler echocardiographic and right-sided hemodynamic recordings were obtained at baseline in all patients, during nitroprusside infusion in the 98 patients who had a baseline restrictive (early-to-late flow velocity ratio > 1 and deceleration time < or = 130 ms) MFVP, and during passive leg lifting in the 75 patients who had a baseline nonrestrictive MFVP. Patients were categorized, according to changes in MFVP, into four groups: 61 patients with an irreversible restrictive, 37 with a reversible restrictive, 48 patients with a stable nonrestrictive, and 27 patients with an unstable nonrestrictive MFVP. Fifty patients experienced major cardiac events. Cox analysis revealed that MFVP was a strong predictor of events and that the response to loading manipulations improved its prognostic value. Patients with an irreversible restrictive MFVP had a higher event rate (51%) than patients with a reversible restrictive MFVP (19%). Among patients with a baseline nonrestrictive MFVP, those with a stable nonrestrictive MFVP had the lowest event rate (6%), whereas the event rate was 33% in patients with an unstable nonrestrictive MFVP.
In patients with chronic heart failure, MFVPs provide independent prognostic information. Their prognostic value can be further increased by assessment of the changes induced in them by loading manipulations.
通过多普勒超声心动图评估的二尖瓣血流速度模式（MFVPs）是各种心脏疾病患者生存的有力预测指标。然而，MFVPs可能会根据负荷条件随时间发生变化。我们进行了这项前瞻性研究，以评估负荷操作引起的MFVP变化是否能为173例慢性心力衰竭患者提供额外的预后信息。
所有患者在基线时同时进行多普勒超声心动图和右侧血流动力学记录，98例基线时MFVP为限制性（早期与晚期血流速度比值>1且减速时间≤130毫秒）的患者在硝普钠输注期间进行记录，75例基线时MFVP为非限制性的患者在被动抬腿期间进行记录。根据MFVP的变化，患者被分为四组：61例为不可逆限制性、37例为可逆限制性、48例为稳定非限制性、27例为不稳定非限制性MFVP。50例患者发生了主要心脏事件。Cox分析显示，MFVP是事件的有力预测指标，对负荷操作的反应提高了其预后价值。不可逆限制性MFVP患者的事件发生率（51%）高于可逆限制性MFVP患者（19%）。在基线时MFVP为非限制性的患者中，稳定非限制性MFVP患者的事件发生率最低（6%），而不稳定非限制性MFVP患者的事件发生率为33%。
在慢性心力衰竭患者中，MFVPs提供独立的预后信息。通过评估负荷操作引起的MFVPs变化，其预后价值可进一步提高。
