Prognostic Impact of Functional Mitral Regurgitation in Patients Admitted With Acute Decompensated Heart Failure
Prognostic Impact of Functional Mitral Regurgitation in Patients Admitted With Acute Decompensated Heart Failure
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DOI：
10.1253/circj.cj-15-0663
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发表时间：
2015-12-01
影响因子：
3.3
通讯作者：
Anzai, Toshihisa
中科院分区：
文献类型：
--
作者：
Wada, Yuko;Ohara, Takahiro;Anzai, Toshihisa
背景：功能性二尖瓣返流（FMR）是心力衰竭（HF）和急性失代偿期二尖瓣狭窄的常见并发症。目前尚不清楚是否FMR入院或出院决定的结果。本研究旨在阐明FMR在急性失代偿性HF患者入院或出院时的预后意义。方法和结果：从2006年至2009年，349例急性失代偿性HF患者入选。他们随访了全因死亡和因HF住院的复合终点; 74例（21%）死亡，113例（32%）在2.1 +/- 1.3年内出现复合终点。出院时的中度/重度FMR与复合终点相关（P=0.001），而入院时的FMR与复合终点无关。多变量考克斯比例风险分析显示，出院时中度/重度FMR（风险比[95%置信区间] =1.70 [1.03-2.73] P=0.04）、logBNP和NYHA III/IV级是结局的独立决定因素。出院时BNP >= 200 pg/ml的中/重度FMR是预后因素，
Background: Functional mitral regurgitation (FMR) is a common complication of heart failure (HF) and worsens in acute decompensation. It is unclear whether FMR on admission or discharge determines the outcome. This study aimed to elucidate the prognostic significance of FMR on admission or discharge in patients admitted with acute decompensated HF.Methods and Results: From 2006 to 2009, 349 patients admitted with acute decompensated HF were enrolled. They were followed with the composite endpoint of all-cause death and hospitalization for HF; 74 (21%) died and 113 (32%) developed the composite endpoint during 2.1 +/- 1.3 years. Moderate/severe FMR at discharge was associated with the composite endpoint (P=0.001), whereas that on admission was not. Multivariate Cox proportional hazard analysis showed that moderate/severe FMR (hazard ratio [95% confidence interval] =1.70 [1.03-2.73] P=0.04), logBNP, and NYHA class III/IV at discharge were independent determinants of the outcome. Moderate/ severe FMR at discharge with BNP >= 200 pg/ml was prognostic, but BNP