背景:风湿性二尖瓣狭窄(MS)在亚洲仍然是一个常见且令人担忧的健康问题。经皮球囊二尖瓣成形术(PBMV)是有症状的重度MS和良好瓣膜形态患者的标准治疗方法。然而,在亚洲,关于PBMV后不良心脏结局的发生率和预测因素的研究有限.本研究旨在评估PBMV后风湿性MS患者不良结局的发生率和预测因素。
方法:在泰国的一所高等学术机构,对2002年至2020年间成功接受PBMV的有症状的重度MS患者进行了一项回顾性队列研究。对患者进行随访以评估不良结果,定义为心脏死亡的复合物,心力衰竭住院,重复PBMV,或者二尖瓣手术.进行单变量和多变量分析以确定不良结局的预测因子。P值<0.05被认为是统计学上显著的。
结果:本研究共纳入379例患者(平均年龄43±11岁,80%女性)。在5.9年的中位随访期间(IQR1.7-11.7),74例患者(19.5%)出现不良结局,年度事件率为2.7%。多变量分析表明,年龄(危险比[HR]1.03,95%置信区间[CI]1.008-1.05,p=0.006),显著三尖瓣返流(HR2.17,95%CI1.33-3.56,p=0.002),PBMV后即刻二尖瓣面积(HR0.39,95%CI0.25-0.64,p=0.01),PBMV后即刻二尖瓣返流(HR1.91,95%CI1.18-3.07,p=0.008)是不良结局的独立预测因子.
结论:在有症状的严重风湿性MS患者中,PBMV后不良结局的发生率为每年2.7%.年龄,显著的三尖瓣反流,PBMV后即刻二尖瓣面积,PBMV术后即刻二尖瓣反流被确定为这些不良结局的独立预测因子.
BACKGROUND: Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV.
METHODS: A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of < 0.05 was considered statistically significant.
RESULTS: A total of 379 patients were included in the study (mean age 43 ± 11 years, 80% female). During a median follow-up of 5.9 years (IQR 1.7-11.7), 74 patients (19.5%) experienced adverse outcomes, with an annualized event rate of 2.7%. Multivariable analysis showed that age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008-1.05, p = 0.006), significant tricuspid regurgitation (HR 2.17, 95% CI 1.33-3.56, p = 0.002), immediate post-PBMV mitral valve area (HR 0.39, 95% CI 0.25-0.64, p = 0.01), and immediate post-PBMV mitral regurgitation (HR 1.91, 95% CI 1.18-3.07, p = 0.008) were independent predictors of adverse outcomes.
CONCLUSIONS: In patients with symptomatic severe rheumatic MS, the incidence of adverse outcomes following PBMV was 2.7% per year. Age, significant tricuspid regurgitation, immediate post-PBMV mitral valve area, and immediate post-PBMV mitral regurgitation were identified as independent predictors of these adverse outcomes.