Dynamic severe mitral regurgitation on hospital arrival as prognostic predictor in patients hospitalized for acute decompensated heart failure
Dynamic severe mitral regurgitation on hospital arrival as prognostic predictor in patients hospitalized for acute decompensated heart failure
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DOI：
10.1016/j.ijcard.2018.09.093
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发表时间：
2018-12-15
影响因子：
3.5
通讯作者：
Kadota, Kazushige
中科院分区：
文献类型：
--
作者：
Kubo, Shunsuke;Kawase, Yuichi;Kadota, Kazushige
背景：急性失代偿性心力衰竭（ADHF）发病时入院时出现的严重二尖瓣反流（MR）在 ADHF 治疗后可以得到改善，因为 MR 本质上是动态的。本研究探讨了 ADHF 患者入院时动态严重 MR 的临床意义。方法：对 784 例因 ADHF 住院的患者在入院时和 ADHF 治疗后进行经胸超声心动图检查，其中 563 例 ADHF 治疗后至少有轻度 MR 的患者入组，并根据 MR 严重程度分为 3 组：两次均严重（持续 MR，n = 106）；抵达时严重，ADHF 治疗后改善为轻度/中度（动态 MR. n = 149）；两次都是轻度/中度（不显着 MR，n 308）。主要结局指标定义为一年内心源性死亡、心力衰竭再住院和二尖瓣介入治疗的综合结果。 结果：动态 MR 组主要结局指标的发生率 (44.8%) 显着高于非显着 MR 组 (22.1%，调整后风险比 [HR]：0.50，95% 置信区间 [CI]：0.34-0.73，P < 0.001），与持续性 MR 组相似（44.4%，调整后 HR：1.08，95% a 0.69-1.67，P = 0.75）。动态 MR 的风险在患者亚组中是一致的（
Background: Severe mitral regurgitation (MR) on hospital arrival at the onset of acute decompensated heart failure (ADHF) can improve after ADHF treatment because MR is dynamic in nature. This study investigated the clinical significance of the dynamic severe MR on hospital arrival in ADHF patients.Methods: Transthoracic echocardiography was performed on 784 patients hospitalized for ADHF both on arrival and after ADHF treatment, of whom 563 with at least mild MR after ADHF treatment were enrolled and divided into 3 groups based on the MR severity: severe at both times (persistent MR, n = 106); severe on arrival and improved to mild/moderate after ADHF treatment (dynamic MR. n = 149); and mild/moderate at both limes (non-significant MR, n 308). The primary outcome measure was defined as a composite of cardiac death, rehospitalization for heart failure, and mitral valve intervention within 1-year.Results: The incidence of the primary outcome measure in the dynamic MR group (44.8%) was significantly higher than that in the non-significant MR group (22.1%, adjusted hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.34-0.73, P < 0.001), and similar to that in the persistent MR group (44.4%, adjusted HR: 1.08, 95% a 0.69-1.67, P = 0.75). The risk of dynamic MR was consistent in the subgroups of patients with reduced (