Impact of Preoperative Anterior Leaflet Tethering on the Recurrence of Ischemic Mitral Regurgitation and the Lack of Left Ventricular Reverse Remodeling after Restrictive Annuloplasty
Impact of Preoperative Anterior Leaflet Tethering on the Recurrence of Ischemic Mitral Regurgitation and the Lack of Left Ventricular Reverse Remodeling after Restrictive Annuloplasty
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DOI：
10.1016/j.echo.2011.09.015
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发表时间：
2011-12-01
影响因子：
6.5
通讯作者：
Maessen, Jos
中科院分区：
文献类型：
--
作者：
Gelsomino, Sandro;van Garsse, Leen;Maessen, Jos
背景资料：这项多中心研究的目的是调查术前二尖瓣前叶栓系角α '对小尺寸二尖瓣环成形术后二尖瓣返流（MR）复发和左心室（LV）逆向重构（LVRR）的影响。第1组，α ′ < 39.5度（n = 196），第2组，α ′ ≥ 39.5度（n = 166）。终点为复发MR ≥ 2+; LVRR，定义为收缩末期容积指数减少> 15%; LV几何逆向重构，定义为收缩期球形指数减少至正常值0.05）。当我们考虑到α和其他危险因素之间的相互作用时，这种影响也发生在低风险亚组中，在高风险患者中是等效的或通常减弱的。α '与任何协变量之间没有显著的相互作用（所有P值> 0.05）。结论：二尖瓣前叶栓系是二尖瓣环成形术后二尖瓣返流复发和LVRR缺乏的有力预测因素。应将瓣叶系留评价纳入临床风险评估和预测模型。（J Am Soc Echocardiogr 2011;24：1365-75.）
Background: The aim of this multicenter study was to investigate the impact of the preoperative anterior mitral leaflet tethering angle, alpha', on the recurrence of mitral regurgitation (MR) and left ventricular (LV) reverse remodeling (LVRR) after undersized mitral ring annuloplasty.Methods: The study population consisted of 362 patients, who were divided into two groups by baseline alpha': group 1, alpha' < 39.5 degrees (n = 196), and group 2, alpha' >= 39.5 degrees (n = 166). End points were recurrent MR >= 2+; LVRR, defined as a reduction in end-systolic volume index > 15%; and LV geometric reverse remodeling, defined as a reduction in systolic sphericity index to a normal value of .05). When we allowed for interactions between alpha' and other risk factors, this effect occurred also in low-risk subgroups, and it was equivalent or generally attenuated in higher risk patients. There were no significant interactions between alpha' and any of the covariates (all P values > .05).Conclusions: Anterior mitral leaflet tethering is a powerful predictor of MR recurrence and lack of LVRR after undersized mitral ring annuloplasty. Evaluation of leaflet tethering should be incorporated into clinical risk assessment and prediction models. (J Am Soc Echocardiogr 2011;24:1365-75.)