目的:二尖瓣反流(MR)对无症状患者的影响尚不明确。我们的目的是在一个大型未选择的无症状MR队列中确定MR相关并发症的患病率及其与10年生存率的关系。
方法:来自德国第二大健康保险基金的健康保险索赔数据,BARMER,它维护着870万德国居民的纵向数据,进行回顾性分析。纳入所有在一个日历年中至少有两个季度的门诊诊断为MR的患者,并在2008年至2011年之间首次记录诊断。排除因MR或二尖瓣介入而出现任何并发症的患者。比较研究组与年龄和性别匹配的对照组之间的结果(即,没有已知的心脏病)。感兴趣的MR相关并发症是新的充血性心力衰竭,新发心房颤动,肺动脉高压,或者心脏代偿失调.
结果:共有56,577人(中位年龄68岁,67%的女性)患有无症状的MR。十年后,与MR相关的并发症在研究组中更为常见。对照组(46.5%vs.20.8%,OR3.31,P<0.0001)。此外,MR相关并发症在男性和男性中更常见。女性患者无症状MR(OR2.65,P<0.0001)。至少1例MR相关并发症的发生与10年生存率降低相关(OR1.80,P<0.0001)。
结论:几乎一半的无症状MR患者在10年的随访期间会出现并发症,导致生存受损。这些结果暗示了长期疾病管理计划的必要性。此外,应重新评估无症状患者二尖瓣介入治疗的决策过程和时机.
OBJECTIVE: The impact of mitral regurgitation (MR) in asymptomatic patients is not well defined. We aimed to determine the prevalence of MR-related complications and their association with 10-year survival in a large unselected asymptomatic MR cohort.
METHODS: Health insurance claims data from Germany\'s second largest health insurance fund, BARMER, which maintains longitudinal data on 8.7 million German residents, were retrospectively analyzed. All patients with an outpatient diagnosis of MR in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011 were included. Patients with any complication attributable to MR or mitral valve intervention at index were excluded. Outcomes were compared between study group and age- and sex-matched controls (i.e., without known cardiac disease). MR-related complications of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation.
RESULTS: A total of 56,577 individuals (median age 68 years, 67% female) with asymptomatic MR were identified. At 10 years, MR-related complications were more frequent in the study group vs. control group (46.5% vs. 20.8%, OR 3.31, P < 0.0001). Furthermore, MR-related complications were more common in male vs. female patients with an asymptomatic MR (OR 2.65, P < 0.0001). The occurrence of at least one MR-related complication was associated with a reduced 10-year survival (OR 1.80, P < 0.0001).
CONCLUSIONS: Almost half of patients with asymptomatic MR experience complications during a 10 year follow-up which result in impaired survival. These results imply the necessity of long-term disease management program. Furthermore, decision-making process and timing for mitral valve intervention in asymptomatic patients should be reevaluated.