右心室功能障碍预测原发性二尖瓣反流经导管二尖瓣修复术后疗效的临床价值  

Clinical value of right ventricular dysfunction in predicting the efficacy of primary mitral regurgitation after catheter mitral valve repair

作　　者：霍文霞[1] 段咏梅[1] 常虹[1] 吕文魁[1] HUO Wenxia;DUAN Yongmei;CHANG Hong;LV Wenkui(Center of Cardiovascular Disease,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心血管病中心,830054

出　　处：《心肺血管病杂志》2024年第5期478-485,共8页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨右心室功能障碍(right ventricular dysfunction,RVD)预测原发性二尖瓣反流(mitral regurgitation,MR)经导管二尖瓣修复术(transcatheter mitral valve repair,TMVR)后疗效的临床价值。方法:选取2019年3月至2021年5月在我院就诊的60例症状性MR患者作为研究对象,根据CMR中右心室射血分数(right ventricular ejection fraction,RVEF)是否低于45%,分为MR+RVD组(n=25)及单纯MR组(n=35)。探讨RVD对预测MR患者术后死亡和再入院的价值。结果:16例患者(26.7%)显示右心室扩张。随访期间,14例患者全因死亡(23.3%),20例(33.3%)患者因心力衰竭等原因再次入院。根据受试者工作特征曲线,RVEF预测死亡和再入院的最佳截断值分别为34.6%和44.9%。MR患者中左右心室舒收缩期容积指数、左右心室每搏量指数、LVEF与REVF均呈正相关性(r=0.420、0.490、0.447,P<0.05)。RVEF与肺动脉收缩压呈负相关(r=-0.292,P=0.028)。Cox模型结果显示调整左心室参数后,RVD也可预测再入院风险和全因死亡风险(P<0.05)。与单纯MR组患者相比,MR+RVD组患者的再入院时间和全因死亡时间缩短(P<0.05)。结论:即使在有效的TMVR之后,术前RVD也与不良预后相关。同时出现RVD、右心室扩张和肺动脉高压的患者队列显示出更高的全因死亡率。Objective:To investigate the clinical value of right ventricular dysfunction(RVD)in predicting the efficacy of primary mitral regurgitation(MR)after transcatheter mitral valve repair(TMVR).Methods:A total of 60 patients with moderate to symptomatic MR who visited our hospital from March 2019 to May 2021 were enrolled as the study subjects.According to whether the right ventricular ejection fraction(RVEF)in cardiovascular magnetic resonance imaging(CMR)was lower than 45%,they were divided into an MR+RVD group(n=25)and a simple MR group(n=35).To explore the value of RVD in predicting postoperative mortality and hospital readmissions in patients with MR.Results:Sixteen patients(26.7%)showed right ventricular(RV)dilation.During followed up,fourteen patients died from all causes(23.3%)and twenty patients(33.3%)were readmitted to the hospital due to heart failure and other reasons.According to the receiver operating characteristic curve,the cut-off values of RVEF to predict death and readmissions was 34.6% and 44.9%.In patients with MR,there were positive correlations between left and right ventricular systolic volume index,left and right ventricular stroke volume index,LVEF and REVF(r=0.420,0.490,0.447;P<0.05).RVEF was inversely correlated with pulmonary artery systolic blood pressure(r=-0.292,P=0.028).After adjusting left ventricular parameters,RVD can also predict the risk of read mission and all-cause death(P<0.05).Compared with the MR group alone,the time to readmission and all-cause death in the MR+RVD group were shorter(P<0.05).Conclusions:Even after an effective TMVR,preoperative RVD is associated with a poor prognosis.Cohorts of patients with concurrent RVD,RV dilation,and pulmonary hypertension showed higher all-cause mortality.

关 键 词：右心室功能障碍 原发性二尖瓣反流 经导管二尖瓣修复术 预后 

分 类 号：R54[医药卫生—心血管疾病]