老年患者二尖瓣反流水平与左室射血分数相关性的随访研究

目的研究老年患者（年龄>60岁）不同程度二尖瓣反流（MR）与随访2年后左室射血分数（LVEF）变化的相关性。方法选
取522名具有轻度或以上的慢性器质性MR老年患者，按病因分为缺血性MR（IMR）组和非缺血性MR（NIMR）组。对入选患者
建立详细的医疗档案，要求患者每年到我院复查超声心动图、复诊并电话随访。随访2年后对收集完整的资料进行统计学分
析。结果（1）MR程度与LVEF均值成负相关，中、重度IMR患者LVEF均值均低于相同程度的NIMR患者（P<0.05）；（2）随访2
年后，在调整了年龄、性别、体质量指数、糖尿病、高血压病、房颤等多因素基础上，IMR组轻、中、重度MR患者LVEF降低程度分
别为.7% (1.4~4.1)，2.7% (1.3~4.0)，5.2% (3.5~6.9)，趋势P值=0.04；NIMR组轻度、中度、重度MR患者LVEF降低程度分别为
3.2% (1.6~4.8)，3.0%(1.4~4.5)，1.7%(-0.5~3.9)，趋势P值=0.30。结论MR返流程度越大，LVEF均值越低，中、重度IMR患者
LVEF均值低于相同程度的NIMR患者，针对重度IMR患者的分层管理将有助于改善其LVEF。

Correlation between mitral regurgitation grading and left ventricular ejection fraction in elderly patients: a follow-up study

Objective To analyze the correlation between mitral regurgitation grading and left ventricular ejection fraction in elderly patients(>60 years of age) in a 2-year follow-up.Methods A total of 455 patients with the diagnosis of at least mild mitral regurgitation by echocardiography were divided into ischemic mitral regurgitation(IMR) group and non-ischemic regurgitation(NIMR) group.The patients were followed up with echocardiography every 6 months and the data were analyzed at the end of 24 months.Results Mitral regurgitation grade was inversely correlated with left ventricular ejection fraction(LVEF).Patients with moderate and severe IMR had a lower LVEF than those with NIMR(P<0.05).After adjustment for age,sex,body mass index,high blood pressure,diabetes,atrial fibrillation and cardiomyopathy,the mean LVEF at 2 years was lowered by 2.7%(1.4%-4.1%),2.7%(1.3%-4.0%),and 5.2%(3.5%-6.9%) in mild,moderate and severe IMR patients,respectively(P<0.04),and by 3.2%(1.6%-4.8%),and 3.0%(1.4%-4.5%),and 1.7%(-0.5%-3.9%) in mild,moderate and severe NIMR patients(P=0.30).Conclusion The mean LVEF in IMR patients is significantly lowered compared to that in NIMR patients.The grade of mitral regurgitation is inversely correlated with the regurgitation area in IMR patients.Stratified management might help improve LVEF in severe IMR patients.