Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction.
Impact of secondary mitral regurgitation on survival in atrial and ventricular dysfunction.
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DOI：
10.1371/journal.pone.0277385
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
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心房和心室继发性二尖瓣反流（SMR）的自然史尚不清楚。我们比较了SMR程度对心房和心室功能障碍患者生存的影响。我们对2013-2018年间在医疗网络中接受超声心动图检查的患者进行了回顾性队列研究。我们比较了心房和心室功能障碍患者的生存率，使用倾向评分，根据患者人口统计学和SMR严重程度（无、轻度、中度或重度）的合并症的差异得出倾向评分。我们拟合Cox比例风险模型，以估计心房和心室功能障碍患者在不同严重程度的SMR中经风险调整后的死亡风险。在纳入的11,987例患者中（中位年龄69岁[IQR 58-80]， 46%为女性），6254例（52%）有孤立性心房功能障碍，5733例（48%）有心室功能障碍。每组3522例患者采用粗化精确匹配。无SMR的心房功能障碍死亡风险与无SMR的心室功能障碍相当（HR 1.1, 95% CI 0.9-1.3）。以无SMR的心室功能障碍为参照，随着SMR严重程度的增加，室性功能障碍的死亡风险仍然高于心房功能障碍：轻度SMR（心室功能障碍的HR为2.1,95%CI为1.8-2.4，心房功能障碍的HR为1.7,95%CI为1.5-2.0）和中度/重度SMR （HR为2.8,95%CI为2.4 - 3.4,95%CI为2.4,95%CI为2.0-2.9）。所有严重程度的SMR与心房功能障碍患者的生存率均高于室性功能障碍患者，尽管随着SMR严重程度的增加，心房功能障碍和室性功能障碍患者的生存率递减幅度相似。
Natural history of atrial and ventricular secondary mitral regurgitation (SMR) is poorly understood. We compared the impact of the degree of SMR on survival between atrial and ventricular dysfunction. We conducted a retrospective cohort study of patients who underwent echocardiography in a healthcare network between 2013–2018. We compared the survival of patients with atrial and ventricular dysfunction, using propensity scores developed from differences in patient demographics and comorbidities within SMR severity strata (none, mild, moderate or severe). We fitted Cox proportional hazards models to estimate the risk-adjusted hazards of death across different severities of SMR between patients with atrial and ventricular dysfunction. Of 11,987 patients included (median age 69 years [IQR 58–80]; 46% women), 6,254 (52%) had isolated atrial dysfunction, and 5,733 (48%) had ventricular dysfunction. 3,522 patients were matched from each arm using coarsened exact matching. Hazard of death in atrial dysfunction without SMR was comparable to ventricular dysfunction without SMR (HR 1.1, 95% CI 0.9–1.3). Using ventricular dysfunction without SMR as reference, hazards of death remained higher in ventricular dysfunction than in atrial dysfunction across increasing severities of SMR: mild SMR (HR 2.1, 95% CI 1.8–2.4 in ventricular dysfunction versus HR 1.7, 95%CI 1.5–2.0 in atrial dysfunction) and moderate/severe SMR (HR 2.8, 95%CI 2.4–3.4 versus HR 2.4, 95%CI 2.0–2.9). SMR across all severities were associated with better survival in atrial dysfunction than in ventricular dysfunction, though the magnitude of the diminishing survival were similar between atrial and ventricular dysfunction in increasing severity of SMRs.
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影响因子：
1.2
作者：
Matsumori M;Kawashima M;Aihara T;Fujisue J;Fujimoto M;Fukase K;Nomura Y;Tanaka H;Murakami H;Mukohara N
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Mukohara N
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24
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Grigioni, F;Detaint, D;Enriquez-Sarano, M
通讯作者：
Enriquez-Sarano, M
影响因子：
2.7
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Okamoto C;Okada A;Nishimura K;Moriuchi K;Amano M;Takahama H;Amaki M;Hasegawa T;Kanzaki H;Fujita T;Kobayashi J;Yasuda S;Izumi C
通讯作者：
Izumi C