房性与室性功能性二尖瓣反流的预后研究

Prognostic study on atrial and ventricular functional mitral regurgitation

目的探讨不同类型功能性二尖瓣反流(functional mitral regurgitation,FMR)患者的预后。方法纳入2020年1月至2022年1月于我院首次住院的3+级和4+级的FMR患者,中位随访30个月,根据患者的病史和超声心动图特点,分为室性FMR(ventricular functional MR,VFMR)组和房性FMR(atrial functional MR,AFMR)组,收集患者病历资料和预后情况,分析不同类型FMR患者的全因死亡率、心衰再入院率及其影响因素。结果共有357例患者纳入研究,平均年龄65岁,男性230例,女性127例;其中VFMR组273例、AFMR组84例。研究的主要终点为全因死亡率、心力衰竭再入院率和复合终点发生率(全因死亡率和/或因心衰再次入院)。复合终点发生率AFMR组明显低于VFMR组[HR=0.51,95%CI(0.33,0.79),P<0.05]。伴有房颤的FMR复合终点的发生率高于不伴房颤者(VFMR组P<0.01,AFMR组P=0.01)。缺血性和非缺血性VFMR复合终点发生率差异无统计学意义(P=0.24)。高水平BNP(b-type natri-uretic peptide)是VFMR出现心血管事件的独立危险因素,肌酐和左室舒张末内径是AFMR出现心血管事件的独立危险因素。结论AFMR预后明显好于VFMR,两者的预后因素不同。

Objective To investigate the prognosis of patients with different types of functional mitral regurgitation(FMR).Methods The study included patients with grade 3+and grade 4+FMR who were admitted to our hospital for the first time between January 2020 to January 2022.The median follow-up period was 30 months.Based on the patients'medical history and echocardiography characteristics,they were categorized into the ventricular FMR(VFMR)group and the atrial FMR(AFMR)group.Medical records and prognosis data were collected and then analyzed to determine the all-cause mortality rate and heart failure readmission rate of patients with different types of FMR and their influencing factors.Results A total of 357 patients were included in the study,with a mean age of 65 years.There were 230 males and 127 females.Among them,there were 273 cases in the VFMR group and 84 cases in the AFMR group.The main endpoints of the study were all cause mor-tality,heart failure readmission rate,and the composite endpoint occurrence rate of both.The composite endpoint occurence rate in the AFMR group were significantly lower than those in the VFMR group[HR=0.51,95%CI(0.33,0.79),P<0.05].The occurrence rate of the composite endpoint in FMR patients with atrial fibrillation was higher than that in those with-out atrial fibrillation(VFMR group P<0.01,AFMR group P=0.01).There was no significant difference in the occurrence rate of the composite endpoint between ischemic and non-ischemic VFMR(P=0.24).Cox regression analysis was used to ana-lyze the main influencing factors of composite endpoints.The prognostic factors for VFMR and AFMR were different.High lev-els of B-type natriuretic peptide(BNP)were an independent risk factor for cardiovascular events in VFMR,while creatinine and left ventricular end-diastolic diameter were independent risk factors for cardiovascular events in AFMR.Conclusion The prog-nosis of AFMR is significantly better than that of VFMR,and the prognostic factors differ between the two.