Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction
Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction
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DOI：
10.1016/j.jacc.2004.10.030
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发表时间：
2005-01-18
影响因子：
24
通讯作者：
Enriquez-Sarano, M
中科院分区：
文献类型：
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作者：
Grigioni, F;Detaint, D;Enriquez-Sarano, M
目的本研究的目的是确定缺血性二尖瓣反流（IMR）对心肌梗死（MI）后充血性心力衰竭（CHF）发生的贡献。背景MI后，CHF是一种常见且严重的并发症，但其决定因素，特别是，IMR作用定义不明确。方法我们分析了173例既往Q波MI的无症状患者（>16天）与IMR的超声心动图定量（测量有效返流口[ERO]和返流体积）。102例IMR患者与71例无IMR患者的年龄相匹配（71 11岁vs. 68 9岁; p = 0.11），性别（76% vs. 82%男性; p = 0.41）和左心室射血分数（EF）结果CHF和CHF或心源性死亡（CD）的5年发生率分别为36 +/- 5%和52 +/-5%。CHF的独立决定因素是EF、血浆钠水平、IMR的存在和程度（p < 0.0001）。无二尖瓣返流（MR）时5年CHF发生率为18 +/- 5%，有IMR时为53 +/- 7%，ERO 1 ~ 19 mm（2）时为46 +/- 9%，ERO ≥ 20 mm（2）时为68 +/- 12%（均p < 0.0001）。IMR存在时CHF的校正相对危险度为3.65（95%置信区间[CI] 1.86 - 7.75），ERO大于或等于20 mm（2）时为4.42（95% CI 1.9 - 10.5）。IMR患者CHF/CD的校正相对危险度为2.97（95%CI 1.77 ~ 5.16），ERO ≥ 20 mm（2）患者CHF/CD的校正相对危险度为4.4（95%CI 2.4 ~ 8.2）。结论：MI后，CHF和CHF/CD的发生率即使在基线时无症状或症状轻微的患者中也很高，在IMR患者中更高。充血性心力衰竭是由IMR的较大ERO独立决定的。这些数据表明，检测和量化IMR是必不可少的MI后的危险分层。应研究IMR治疗在改善MI后结局方面的价值。(C)2005年，美国心脏病学会基金会。
OBJECTIVES The purpose of this study was to define the contribution of ischemic mitral regurgitation (IMR) to the occurrence of congestive heart failure (CHF) after myocardial infarction (MI).BACKGROUND After MI, CHF is a frequent and serious complication, but its determinants and, particularly, the role of IMR are poorly defined.METHODS We analyzed 173 asymptomatic patients with previous Q-wave MI (>16 days) with echocardiographic quantitation of IMR (measuring effective regurgitant orifice [ERO] and regurgitant volume). The 102 patients with IMR were matched to 71 patients without IMR for age (71 11 years vs. 68 9 years; p = 0.11), gender (76% vs. 82% males; p = 0.41), and left ventricular ejection fraction (EF) (37 +/- 14% vs. 36 +/- 11%; p = 0.92).RESULTS Five-year rates of CHF and of CHF or cardiac death (CD) were 36 +/- 5% and 52 +/- 5%, respectively. Independent determinants of CHF were EF, sodium plasma level, and presence and degree of IMR (p < 0.0001). Five-year CHF rates were 18 +/- 5% without mitral regurgitation (MR), 53 +/- 7% with IMR, 46 +/- 9% with ERO 1 to 19 mm(2) and 68 +/- 12% with ERO greater than or equal to20 mm(2) (all p < 0.0001). The adjusted relative risk of CHF was 3.65 (95% confidence interval [CI] 1.86 to 7.75) for IMR presence and 4.42 (95% CI 1.9 to 10.5) for ERO greater than or equal to20 mm(2). The adjusted relative risk of CHF/CD was 2.97 (95% CI 1.77 to 5.16) for IMR presence and 4.4 (95% CI 2.4 to 8.2) for ERO greater than or equal to20 mm(2).CONCLUSIONS After MI, incidence of CHF and of CHF/CD are high even in patients with no or minimal symptoms at baseline and are higher in patients with IMR. Congestive heart failure is independently determined by larger ERO of IMR. These data suggest that detecting and quantifying IMR is essential for risk stratification after MI. Value of IMR treatment in improving post-MI outcome should be investigated. (C) 2005 by the American College of Cardiology Foundation.