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奥地利维也纳医科大学Georg Goliasch研究了心力衰竭患者继发性二尖瓣反流的负担、治疗方法和预后。该研究于2021年6月30日发表于《英国医学杂志》上。

为了确定心力衰竭患者继发性二尖瓣反流（sMR）的发病率、长期预后和治疗标准，研究组进行了一项大规模队列研究，观察队列研究数据来自2010-2020年奥地利维也纳社区医疗保健提供者网络。共纳入13223例所有心力衰竭亚型的sMR患者。主要结局为根据指南诊断标准分为三种心力衰竭亚型（射血分数降低、中等和保留）的sMR患者与死亡率之间的相关性。

在所有心力衰竭患者中共有1317例（10%）诊断为严重sMR，且与年龄增长相关，在射血分数降低型患者中最为常见，2619例中有656例（25%）。严重sMR患者的死亡率高于同社区、同年龄、同性别人群的预期，风险比为7.53。与无/轻度sMR的心力衰竭患者相比，中度sMR患者的死亡率呈逐步上升趋势，风险比为1.29，重度sMR患者的风险比为1.82。

经多变量校正后，严重sMR与超额死亡率之间的相关性在所有心力衰竭亚组中一致，其中中等射血分数的风险比为2.53，射血分数降低为1.70，射血分数保留为1.52。尽管有最先进的医疗保健、高容量性心力衰竭和瓣膜疾病方案，但严重sMR很少通过外科瓣膜修复（7%）或置换（5%）治疗；低风险经导管修补术（4%）也很少使用。

研究结果表明，二尖瓣反流很常见，随年龄增长而增加，并伴有死亡率增高。心力衰竭与不良结局的相关性是显著的，但在射血分数中等和较低的患者中最为显著。

附：英文原文

Title: Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study

Author: Philipp E Bartko, Gregor Heitzinger, Noemi Pavo, Maria Heitzinger, Georg Spinka, Suriya Prausmüller, Henrike Arfsten, Martin Andreas, Cornelia Gabler, Guido Strunk, Julia Mascherbauer, Christian Hengstenberg, Martin Hülsmann, Georg Goliasch

Issue&Volume: 2021/06/30

Abstract:

Objectives To define prevalence, long term outcome, and treatment standards of secondary mitral regurgitation (sMR) across the heart failure spectrum.

Design Large scale cohort study.

Setting Observational cohort study with data from the Viennese community healthcare provider network between 2010 and 2020, Austria.

Participants 13223 patients with sMR across all heart failure subtypes.

Main outcome measures Association between sMR and mortality in patients assigned by guideline diagnostic criteria to one of three heart failure subtypes: reduced, mid-range, and preserved ejection fraction, was assessed.

Results Severe sMR was diagnosed in 1317 patients (10%), correlated with increasing age (P<0.001), occurred across the entire spectrum of heart failure, and was most common in 656 (25%) of 2619 patients with reduced ejection fraction. Mortality of patients with severe sMR was higher than expected for people of the same age and sex in the same community (hazard ratio 7.53; 95% confidence interval 6.83 to 8.30, P<0.001). In comparison with patients with heart failure and no/mild sMR, mortality increased stepwise with a hazard ratio of 1.29 (95% confidence interval 1.20 to 1.38, P<0.001) for moderate and 1.82 (1.64 to 2.02, P<0.001) for severe sMR. The association between severe sMR and excess mortality was consistent after multivariate adjustment and across all heart failure subgroups (mid-range ejection fraction: hazard ratio 2.53 (95% confidence interval 2.00 to 3.19, P<0.001), reduced ejection fraction: 1.70 (1.43 to 2.03, P<0.001), and preserved ejection fraction: 1.52 (1.25 to 1.85, P<0.001)). Despite available state-of-the-art healthcare, high volume heart failure, and valve disease programmes, severe sMR was rarely treated by surgical valve repair (7%) or replacement (5%); low risk transcatheter repair (4%) was similarly seldom used.

Conclusion Secondary mitral regurgitation is common overall, increasing with age and associated with excess mortality. The association with adverse outcome is significant across the entire heart failure spectrum but most pronounced in those with mid-range and reduced ejection fractions. Despite these poor outcomes, surgical valve repair or replacement are rarely performed; similarly, low risk transcatheter repair, specifically in the heart failure subsets with the highest expected benefit from treatment, is seldom used. The current data suggest an increasing demand for treatment, particularly in view of an expected increase in heart failure in an ageing population.

DOI: 10.1136/bmj.n1421

Source: https://www.bmj.com/content/373/bmj.n1421

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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