J. Thierry, D. Stevant, N. Piriou, P.Y. Turgeon, K. Warin-Fresse, J.M. Serfaty, D. Grimault, T. Le Tourneau
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Myocardial work parameters were assessed using a dedicated software. The primary endpoint associated cardiovascular death, sustained </span>ventricular arrhythmia, heart failure, </span></span>new onset atrial fibrillation<span>, or arterial embolism.</span></p></div><div><h3>Results</h3><p><span>Of the 321 patients 186 (58%) had a GWW (global wasted work) < 120 mmHg% and 135 (42%) a GWW ≥ 120 mmHg%. GWW < 120 mmHg% was associated with echographic and CMR parameters of abnormal filling, volume overload and more severe regurgitation. During a mean follow-up of 4.5</span> <!-->±<!--> <span>2.8 years, censored at the time of mitral valve surgery, 36 cardiovascular events were recorded in the GWW</span> <!--><<!--> <!-->120 mmHg% group versus 14 in the GWW ≥ 120 mmHg% group (19% vs. 10%; <em>P</em> <!-->=<!--> <!-->0.028). Heart failure (15 vs. 6%; <em>P</em> <!-->=<!--> <!-->0.011) and mitral valve intervention (69 vs. 59%; <em>P</em> <!-->=<!--> <span>0.045) rates were higher in the GWW < 120 mmHg% group. Five-year cardiovascular event-free survival was decreased in patients with GWW</span> <!--><<!--> <!-->120 mmHg% (46.6<!--> <!-->±<!--> <!-->7.7% vs. 59.1<!--> <!-->±<!--> <!-->12.4%; <em>P</em> <!-->=<!--> <!-->0.023). 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引用次数: 0
摘要
二尖瓣脱垂(MVP)是原发性二尖瓣反流(MR)的主要原因。由于严重MR的容量负荷引起的改变，评估左心室收缩功能是一个重要的标志，这是转介患者手术的困难。我们研究的目的是在无创心肌功评估的基础上评估心脏力学，通过分析左心室压力-应变循环，考虑到负荷条件。方法共纳入2010 - 2021年间接受全面超声心动图和心脏磁共振(CMR)检查的321例MVP(伴有或不伴有严重MR)患者(63%男性)。使用专用软件评估心肌功参数。主要终点与心血管死亡、持续性室性心律失常、心力衰竭、新发房颤或动脉栓塞相关。结果321例患者中186例(58%)出现GWW (global wasted work);120 mmHg%和135 (42%)GWW≥120 mmHg%。奢华婚礼& lt;还是再想想吧120 mmHg%与超声和CMR参数异常充盈、容量过载和更严重的反流相关。在平均4.5±2.8年的随访期间(剔除二尖瓣手术时间)，GWW <记录了36例心血管事件;GWW≥120 mmHg%组14例(19%对10%;p = 0.028)。心力衰竭(15% vs. 6%;P = 0.011)和二尖瓣介入治疗(69% vs. 59%;P = 0.045);120 mmHg%组。GWW患者的5年无心血管事件生存率降低;120 mmHg%(46.6±7.7% vs. 59.1±12.4%;p = 0.023)。在多变量分析中，MR严重程度、CMR是否存在晚期增强、GWW <120 mmHg% (HR 1.76;95% ci 0.93-3.34;P = 0.085)与无事件生存受损相关。结论心肌检查可为超声心动图和心脏MRI提供额外的诊断和预后信息。
Prognostic contribution of left ventricular myocardial work assessment in mitral valve prolapse
Introduction
Mitral Valve Prolapse (MVP) is the leading cause of primary mitral regurgitation (MR). Due to volume overload-induced changes in severe MR, assessment of left ventricular systolic function, an important marker to refer patients to surgery, is difficult. The aim of our study was to assess cardiac mechanics based on the non-invasive evaluation of myocardial work, by analysing the left ventricular pressure-strain loop, taking into account loading conditions.
Method
In total, 321 patients (63% male) with MVP (with or without severe MR), who underwent a comprehensive echocardiography and cardiac magnetic resonance (CMR) between 2010 and 2021, were included. Myocardial work parameters were assessed using a dedicated software. The primary endpoint associated cardiovascular death, sustained ventricular arrhythmia, heart failure, new onset atrial fibrillation, or arterial embolism.
Results
Of the 321 patients 186 (58%) had a GWW (global wasted work) < 120 mmHg% and 135 (42%) a GWW ≥ 120 mmHg%. GWW < 120 mmHg% was associated with echographic and CMR parameters of abnormal filling, volume overload and more severe regurgitation. During a mean follow-up of 4.5 ± 2.8 years, censored at the time of mitral valve surgery, 36 cardiovascular events were recorded in the GWW < 120 mmHg% group versus 14 in the GWW ≥ 120 mmHg% group (19% vs. 10%; P = 0.028). Heart failure (15 vs. 6%; P = 0.011) and mitral valve intervention (69 vs. 59%; P = 0.045) rates were higher in the GWW < 120 mmHg% group. Five-year cardiovascular event-free survival was decreased in patients with GWW < 120 mmHg% (46.6 ± 7.7% vs. 59.1 ± 12.4%; P = 0.023). In multivariable analysis, MR severity, the presence of late enhancement on CMR, and GWW < 120 mmHg% (HR 1.76; 95% CI 0.93–3.34; P = 0.085) were associated with impaired event-free survival.
Conclusion
Myocardial work-up provides additional diagnostic and prognostic information to echocardiography and cardiac MRI in MV.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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