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Abstract：
OBJECTIVE: Early diastolic mitral annular tissue (e\') velocity is a commonly used marker of left ventricular (LV) diastolic function. This study aimed to investigate the prognostic implications of e\' velocity in patients with mitral regurgitation (MR).
METHODS: This retrospective cohort study included 1,536 consecutive patients aged <65 years with moderate or severe chronic primary MR diagnosed between 2009 and 2018. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. According to the current guidelines, the cut-off value of e\' velocity was defined as 7 cm/s.
RESULTS: A total of 404 individuals were enrolled (median age, 51.0 years; 64.1% male; 47.8% severe MR). During a median 6.0-year follow-up, there were 40 all-cause mortality and 16 cardiovascular deaths. Multivariate analysis revealed a significant association between e\' velocity and all-cause death (adjusted hazard ratio [aHR], 0.770; 95% confidence interval [CI], 0.634-0.935; p=0.008) and cardiovascular death (aHR, 0.690; 95% CI, 0.477-0.998; p=0.049). Abnormal e\' velocity (≤7 cm/s) independently predicted all-cause death (aHR, 2.467; 95% CI, 1.170-5.200; p=0.018) and cardiovascular death (aHR, 5.021; 95% CI, 1.189-21.211; p=0.028), regardless of symptoms, LV dimension and ejection fraction. Subgroup analysis according to sex, MR severity, mitral valve replacement/repair, and symptoms, showed no significant interactions. Including e\' velocity in the 10-year risk score improved reclassification for mortality (net reclassification improvement [NRI], 0.154; 95% CI, 0.308-0.910; p<0.001) and cardiovascular death (NRI, 1.018; 95% CI, 0.680-1.356; p<0.001).
CONCLUSIONS: In patients aged <65 years with primary MR, e\' velocity served as an independent predictor of all-cause and cardiovascular deaths.
METHODS: This retrospective cohort study included 1,536 consecutive patients aged <65 years with moderate or severe chronic primary MR diagnosed between 2009 and 2018. The primary and secondary outcomes were all-cause and cardiovascular mortality, respectively. According to the current guidelines, the cut-off value of e\' velocity was defined as 7 cm/s.
RESULTS: A total of 404 individuals were enrolled (median age, 51.0 years; 64.1% male; 47.8% severe MR). During a median 6.0-year follow-up, there were 40 all-cause mortality and 16 cardiovascular deaths. Multivariate analysis revealed a significant association between e\' velocity and all-cause death (adjusted hazard ratio [aHR], 0.770; 95% confidence interval [CI], 0.634-0.935; p=0.008) and cardiovascular death (aHR, 0.690; 95% CI, 0.477-0.998; p=0.049). Abnormal e\' velocity (≤7 cm/s) independently predicted all-cause death (aHR, 2.467; 95% CI, 1.170-5.200; p=0.018) and cardiovascular death (aHR, 5.021; 95% CI, 1.189-21.211; p=0.028), regardless of symptoms, LV dimension and ejection fraction. Subgroup analysis according to sex, MR severity, mitral valve replacement/repair, and symptoms, showed no significant interactions. Including e\' velocity in the 10-year risk score improved reclassification for mortality (net reclassification improvement [NRI], 0.154; 95% CI, 0.308-0.910; p<0.001) and cardiovascular death (NRI, 1.018; 95% CI, 0.680-1.356; p<0.001).
CONCLUSIONS: In patients aged <65 years with primary MR, e\' velocity served as an independent predictor of all-cause and cardiovascular deaths.
摘要：
目的：早期舒张二尖瓣环组织（e\'）速度是左心室（LV）舒张功能的常用标记。本研究旨在探讨二尖瓣反流（MR）患者的血流速度对预后的影响。
方法：这项回顾性队列研究包括2009年至2018年间诊断为中度或重度慢性原发性MR的1,536名年龄<65岁的连续患者。主要和次要结局是全因死亡率和心血管死亡率，分别。根据目前的指导方针,e'速度的截止值定义为7cm/s。
结果：共纳入404名个体（中位年龄，51.0岁；男性占64.1%；重度MR占47.8%）。在6.0年的中位随访期间，有40例全因死亡和16例心血管死亡.多变量分析显示，速度和全因死亡之间存在显著关联(调整后的风险比[aHR]，0.770；95%置信区间[CI]，0.634-0.935；p=0.008）和心血管死亡（aHR，0.690；95%CI，0.477-0.998；p=0.049）。异常速度(≤7cm/s)独立预测全因死亡(AHR，2.467；95%CI，1.170-5.200；p=0.018）和心血管死亡（aHR，5.021；95%CI，1.189-21.211；p=0.028），不管症状如何,左心室尺寸和射血分数。根据性别进行亚组分析，MR严重程度,二尖瓣置换/修复,和症状，没有表现出显著的相互作用。在10年风险评分中包括e'速度改善了死亡率的重新分类(净重新分类改善[NRI]，0.154；95%CI，0.308-0.910；p<0.001）和心血管死亡（NRI，1.018；95%CI，0.680-1.356；p<0.001)。
结论：在年龄<65岁的原发性MR患者中，电子速度是全因死亡和心血管死亡的独立预测因子。
方法：这项回顾性队列研究包括2009年至2018年间诊断为中度或重度慢性原发性MR的1,536名年龄<65岁的连续患者。主要和次要结局是全因死亡率和心血管死亡率，分别。根据目前的指导方针,e'速度的截止值定义为7cm/s。
结果：共纳入404名个体（中位年龄，51.0岁；男性占64.1%；重度MR占47.8%）。在6.0年的中位随访期间，有40例全因死亡和16例心血管死亡.多变量分析显示，速度和全因死亡之间存在显著关联(调整后的风险比[aHR]，0.770；95%置信区间[CI]，0.634-0.935；p=0.008）和心血管死亡（aHR，0.690；95%CI，0.477-0.998；p=0.049）。异常速度(≤7cm/s)独立预测全因死亡(AHR，2.467；95%CI，1.170-5.200；p=0.018）和心血管死亡（aHR，5.021；95%CI，1.189-21.211；p=0.028），不管症状如何,左心室尺寸和射血分数。根据性别进行亚组分析，MR严重程度,二尖瓣置换/修复,和症状，没有表现出显著的相互作用。在10年风险评分中包括e'速度改善了死亡率的重新分类(净重新分类改善[NRI]，0.154；95%CI，0.308-0.910；p<0.001）和心血管死亡（NRI，1.018；95%CI，0.680-1.356；p<0.001)。
结论：在年龄<65岁的原发性MR患者中，电子速度是全因死亡和心血管死亡的独立预测因子。
