Predictors of Outcome of Mitral Valve Prolapse in Patients With the Marfan Syndrome

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• 作者：Meike Rybczynski MD^a ; ^† ; ; Hendrik Treede MD^a ; ^† ; ; Sara Sheikhzadeh MD^a ; Eike F. Groene MD^a ; Alexander M.J. Bernhardt MD^a ; Mathias Hillebrand MD^a ; Thomas S. Mir MD^a ; Kristine Kü ; hne MD^a ; Dietmar Koschyk MD^a ; Peter N. Robinson MD ; MSc^c ; Jü ; rgen Berger PhD^b ; Hermann Reichenspurner MD ; PhD^a ; Thomas Meinertz MD^a ; Yskert von Kodolitsch MD ; MBA^a ; ^{kodolitsch@uke.de}
• 刊名：The American Journal of Cardiology
• 出版年：2011
• 出版时间：15 January 2011
• 年：2011
• 卷：107
• 期：2
• 页码：268-274
• 全文大小：753 K

文摘

Mitral valve prolapse has a prevalence of 2 % to 3 % in the general population, with adverse outcomes such as mitral valve regurgitation (MVR), heart failure, and endocarditis. Predictors of outcomes are used in idiopathic mitral valve prolapse for the timing of surgery, but such predictors are unknown in Marfan syndrome. Therefore, a population-based cohort study of 112 patients (49 male, 63 female; mean age 34 ± 15 years) with classic Marfan syndrome and mitral valve prolapse with moderate or less MVR at baseline was conducted. During 4.6 ± 3.6 years of follow-up, progression of MVR was observed in 41 patients and valve-related events, which comprised mitral valve endocarditis (7 events), heart failure (5 events), and mitral valve surgery (25 events), were observed in 31 patients. Multivariate Cox proportional-hazards regression analysis identified a flail mitral leaflet (hazard ratio [HR] 3.262, 95 % confidence interval [CI] 1.406 to 7.566, p = 0.006) and increased indexed end-systolic left ventricular diameters (HR 1.113, 95 % CI 1.043 to 1.188, p = 0.001) as independent predictors of progression of MVR. Similarly, mitral valve–related events were independently predicted by a flail mitral leaflet (HR 5.343, 95 % CI 2.229 to 12.808, p <0.001), and mild (HR 14.336, 95 % CI 1.873 to 109.755, p = 0.01) or moderate (HR 16.849, 95 % CI 2.205 to 128.76, p = 0.006) degree of MVR. Conversely, aortic dilatation, dural ectasia, and sporadic mode of inheritance were not associated with outcome. In conclusion, the same clinical determinants that predict outcomes in idiopathic mitral valve prolapse also predict outcomes in mitral valve prolapse associated with Marfan syndrome.