IDENTIFICATION OF HIGH-RISK AND LOW-RISK SUBGROUPS OF PATIENTS WITH MITRAL-VALVE PROLAPSE
IDENTIFICATION OF HIGH-RISK AND LOW-RISK SUBGROUPS OF PATIENTS WITH MITRAL-VALVE PROLAPSE
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DOI：
10.1056/nejm198904203201602
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发表时间：
1989-04-20
影响因子：
158.5
通讯作者：
WEYMAN, AE
中科院分区：
文献类型：
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作者：
MARKS, AR;CHOONG, CY;WEYMAN, AE
二尖瓣脱垂是一种常见的心脏瓣膜疾病，其严重程度和临床结局各不相同。二尖瓣脱垂的标准定义的缺乏可以解释报告的并发症发生率的变化。为了识别高风险和低风险亚组，我们回顾性分析了456例二尖瓣脱垂患者的临床和二维超声心动图数据。二尖瓣脱垂根据超声心动图结果定义为胸骨旁长轴视图中一个或两个瓣叶收缩期移位进入左心房，超出二尖瓣环平面。比较了两组患者：二尖瓣瓣叶增厚和冗余（指定为经典型; n = 319）和瓣叶不增厚（指定为非经典型; n = 137）。两组在年龄和性别比例上相似。并发症或并发症史在经典型比非经典型更常见：感染性心内膜炎，分别为3.5%和0%（P < 0.02）;中度至重度二尖瓣返流，分别为12%和0%（P < 0.001）;需要二尖瓣置换，分别为6.6%和0.7%（P < 0.02）。然而，两组中风的频率相似：7.5%和5.8%（P不显著）。我们的结论是，在选定的二尖瓣脱垂患者人群中，那些具有经典形式（瓣叶增厚和冗余）的二尖瓣脱垂患者的感染和血流动力学并发症的风险高于那些没有这些特征的患者，但不是中风。
Mitral-valve prolapse is a common cardiac valvular disorder with a wide range of severity and diverse clinical outcomes. The lack of a standard definition of mitral-valve prolapse may explain the variation in reported complication rates. To identify high-risk and low-risk subgroups, we retrospectively analyzed clinical and two-dimensional echocardiographic data from 456 patients with mitral-valve prolapse. Mitral-valve prolapse was defined on the basis of echocardiographic findings as systolic displacement into the left atrium of one or both leaflets beyond the plane of the mitral annulus in the parasternal long-axis view. Two groups of patients were compared: those with thickening of the mitral-valve leaflets and redundancy (designated the classic form; n = 319) and those without leaflet thickening (designated the nonclassic form; n = 137). The two groups were similar in age and sex ratio. Complications or a history of complications were more prevalent in the classic than the nonclassic form: infective endocarditis, 3.5 percent and 0 percent, respectively (P < 0.02); moderate-to-severe mitral regurgitation, 12 percent and 0 percent (P < 0.001); and the need for mitral-valve replacement, 6.6 percent and 0.7 percent (P < 0.02). However, the frequency of stroke was similar in the two groups: 7.5 percent and 5.8 percent (P not significant). We conclude that in a selected population of patients with mitral-valve prolapse, those with the classic form (leaflet thickening and redundancy) are at higher risk than those without these features for the infectious and hemodynamic complications of mitral-valve prolapse, but not for stroke.