Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction
Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction
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DOI：
10.1016/j.jacc.2004.09.073
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发表时间：
2005-02-01
影响因子：
24
通讯作者：
Koelling, TM
中科院分区：
文献类型：
--
作者：
Wu, AH;Aaronson, KD;Koelling, TM
目的 本研究旨在评估二尖瓣瓣环成形术 (MVA) 对二尖瓣反流 (MR) 和左心室 (LV) 收缩功能障碍患者死亡率的影响。 背景 二尖瓣瓣环成形术改善了这些患者的血流动力学和症状，但对长期死亡率的影响尚未明确。 1995 年至 2002 年间进行的超声心动图检查。Cox 回归分析（包括作为时间依赖性协变量的 MVA 和根据接受 MVA 的不同概率进行调整的倾向评分）用于确定死亡、左心室辅助装置植入或联合器官共享网络 1 心脏移植的预测因素。 结果 在 682 名患者中，419 名被认为是手术候选者；419 名被认为是手术候选者。 126 人接受了 MVA。倾向评分推导确定了年龄、射血分数和左心室尺寸与接受 MVA 相关。 120 名（41%）非 MVA 患者和 62 名（49%）MVA 患者达到了终点。终点风险增加与冠状动脉疾病（风险比[HR] 1.80，95%置信区间[CI] 1.30至2.49）、血尿素氮（HR 1.01，95% CI 1.005至1.02）、癌症（HR 2.77，95% CI 1.45至5.30）和地高辛（HR 1.66， 95% CI 1.15 至 2.39）。风险降低与血管紧张素转换酶抑制剂（HR 0.65，95% Cl 0.44至0.95）、β受体阻滞剂（FIR 0.59，95% Cl 0.42至0.83）、平均动脉压（HR 0.98，95% Cl 0.97至0.99）和血清钠（HR 0.93， 95% Cl 0.90 至 0.96）。二尖瓣瓣环成形术不能预测临床结果。 结论 在本次分析中，对于伴有严重左心功能不全的显着 MR 而言，MVA 并不能明显降低死亡率。需要进行前瞻性随机对照试验来进一步研究该人群中 MVA 的死亡率。 (C) 2005 年由美国心脏病学会基金会资助。
OBJECTIVES This study was designed to assess effects of mitral valve annuloplasty (MVA) on mortality in patients with mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction.BACKGROUND Mitral valve annuloplasty improves hemodynamics and symptoms in these patients, but effects on long-term mortality are not well established.METHODS We retrospectively analyzed consecutive patients with significant MR and LV systolic dysfunction on echocardiography between 1995 and 2002. Cox regression analysis, including MVA as a time-dependent covariate and propensity scoring to adjust for differing probabilities of undergoing MVA, was used to identify predictors of death, LV assist device implantation, or United Network for Organ Sharing-1 heart transplantation.RESULTS Of 682 patients identified, 419 were deemed surgical candidates; 126 underwent MVA. Propensity score derivation identified age, ejection fraction, and LV dimension to be associated with undergoing MVA. End points were reached in 120 (41%) non-MVA and 62 (49%) MVA patients. Increased risk of end point was associated with coronary artery disease (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.30 to 2.49), blood urea nitrogen (HR 1.01, 95% CI 1.005 to 1.02), cancer (HR 2.77, 95% Cl 1.45 to 5.30), and digoxin (HR 1.66, 95% CI 1.15 to 2.39). Reduced risk was associated with angiotensin-converting enzyme inhibitors (HR 0.65, 95% Cl 0.44 to 0.95), beta-blockers (FIR 0.59, 95% Cl 0.42 to 0.83), mean arterial pressure (HR 0.98, 95% Cl 0.97 to 0.99), and serum sodium (HR 0.93, 95% Cl 0.90 to 0.96). Mitral valve annuloplasty did not predict clinical outcome.CONCLUSIONS In this analysis, there is no clearly demonstrable mortality benefit conferred by MVA for significant MR with severe LV dysfunction. A prospective randomized control trial is warranted for further study of mortality with MVA in this population. (C) 2005 by the American College of Cardiology Foundation.