Influence of mitral valve morphology on mitral balloon commissurotomy: immediate and six-month results from the NHLBI Balloon Valvuloplasty Registry.
Influence of mitral valve morphology on mitral balloon commissurotomy: immediate and six-month results from the NHLBI Balloon Valvuloplasty Registry.
复制标题
二尖瓣形态对二尖瓣球囊连合切开术的影响：NHLBI 球囊瓣膜成形术登记处的即时和六个月结果。
DOI：
10.1016/0002-8703(92)90274-y
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发表时间：
1992
影响因子：
4.8
通讯作者：
McKay,CR
中科院分区：
文献类型：
--
作者：
Reid,CL;Otto,CM;Davis,KB;Labovitz,A;Kisslo,KB;McKay,CR
对 555 名接受二尖瓣球囊连合切开术 (MBC) 的患者的超声心动图数据进行了分析。来自 24 个中心的患者被纳入国家心肺血液研究所球囊瓣膜成形术登记处。其中女性 456 名，男性 99 名，平均年龄 54 岁。 MBC 之前，对二尖瓣厚度、活动度、钙化和瓣膜下疾病的二维超声心动图变量进行评估，并分配 1 至 4 分的分数。二尖瓣形态评分与 MBC 后通过心导管插入术测量的二尖瓣面积 (MVA) 相关。小叶流动性评分与 MBC 后立即 MVA 相关：1 级为 2.2 ± 0.8 cm2，2 级为 1.9 ± 0.7 cm2，3 级为 1.7 ± 0.7 cm2，4 级为 1.9 ± 0.9 cm2 (p< 0.001)。 MBC 后的 MVA 结果显示每个超声心动图变量具有相似的关系。总形态评分（四个变量的总和）与 MBC 后立即的 MVA 关系较弱（r= -0.24），这种关系在 MBC 后 6 个月持续存在（r= -0.25）。多元回归分析显示，MBC 后的 MVA 可以通过 MBC 前的 MVA (p< 0.001)、左心房大小 (p= 0.01)、球囊直径 (p= 0.02)、心输出量 (p= 0.004) 和小叶流动性 (p= 0.01) 来预测。该模型的 R2 为 0.31 (p< 0.001)。总形态评分、瓣叶厚度、钙化和瓣膜下疾病并不是 MBC 结果的重要单变量或多变量预测因子。这些数据表明，虽然二尖瓣形态，特别是小叶活动性，与 MBC 后的 MVA 相关，但其他变量（例如疾病的严重程度和持续时间）也很重要，并且受到手术中使用的较大球囊尺寸的影响。二尖瓣形态不应单独用于选择 MBC 患者。
Echocardiographic data were analyzed in 555 patients undergoing mitral balloon commissurotomy (MBC). Patients were enrolled in the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry from 24 centers. There were 456 women and 99 men with a mean age of 54 years. Before MBC the two-dimensional echocardiographic variables of mitral valve thickness, mobility, calcification, and subvalvular disease were evaluated and assigned scores of 1 to 4. The mitral valve morphology score was related to mitral valve area (MVA) measured after MBC by cardiac catheterization. The leaflet mobility score was related to the immediate post-MBC MVA: 2.2 ± 0.8 cm2for grade 1, 1.9 ± 0.7 cm2for grade 2, 1.7 ± 0.7 cm2for grade 3, and 1.9 ± 0.9 cm2for grade 4 (p< 0.001). Results of the MVA after MBC showed a similiar relationship for each echocardiographic variable. The total morphology score (sum of the four variables) showed a weak relationship to MVA immediately after MBC (r= −0.24), which was persistent at 6 months after MBC (r= −0.25). Multiple regression analysis showed that the MVA after MBC is predicted by pre-MBC MVA (p< 0.001), left atrial size (p= 0.01), balloon diameter (p= 0.02), cardiac output (p= 0.004), and leaflet mobility (p= 0.01). The R2of the model was 0.31 (p< 0.001). Total morphology score, leaflet thickness, calcification, and subvalvular disease were not important univariate or multivariate predictors of the results of MBC. These data suggest that although mitral valve morphology, particularly leaflet mobility, relates to MVA after MBC, other variables such as the severity and duration of disease are also important and are influenced by the larger balloon sizes used in the procedure. Mitral valve morphology should not be used alone in the selection of patients for MBC.