Vaturi M, Sagie A, Shapira Y, Feldman A, Fink N, Strasberg B, Adler Y
Dan Schiengarten Echocardiographic and Valvular Clinic, Department of Cardiology, Rabin Medical Center, Petah Tiqva, Israel.
J Heart Valve Dis. 2001 Nov;10(6):763-6.
The association between mitral valve disease and atrial fibrillation (AF) is well known, but few data exist regarding the impact of AF after mitral valve replacement (MVR) on NYHA functional class, atrial size and hemodynamic parameters. The present study was conducted to evaluate these issues.
Eighty-six patients (26 men, 60 women) who underwent MVR were evaluated by transthoracic echocardiography. Fifty-nine patients had chronic AF (AF group), and 27 were in sinus rhythm (sinus group). Variables analyzed included end-systolic left atrial and right atrial areas, tricuspid regurgitation, and presence and duration of AF. Peak and mean transprosthetic mitral valve gradients and pulmonary pressure were estimated by Doppler echocardiography.
Groups were matched for age, sex and time from MVR (mean 6.6 years). Sixty-four patients (77%) had rheumatic heart disease, 18 (21%) had mitral valve disease, and two (2%) had mitral valve prolapse. Mean duration of AF was 11+/-12 years (range: 8-50 years). Preoperatively, AF patients had a worse NYHA class than sinus patients (2.8+/-0.8 versus 1.1+/-0.7, p = 0.001), but both had similar fractional shortening of the left ventricle and preserved prosthetic mitral valve function. Multivariate analysis identified AF as a single predictor of NYHA class after MVR. Although left and right atrial areas were larger in AF patients (47+/-25 versus 27+/-7 cm2, p = 0.0001 and 30+/-12 versus 17+/-5 cm2, p = 0.0001, respectively), the left:right atrial size ratio was not significantly different between groups. Multivariate analysis identified mean transmitral gradient and duration of AF as independent predictors of left atrial size after MVR (p = 0.01 and p = 0.0001, respectively). Tricuspid regurgitation and duration of AF were independent predictors of right atrial size (p = 0.003 and p = 0.0001, respectively).
The presence of AF after MVR is associated with a worse NYHA functional class, increased transmitral gradients, and larger areas of both atria, when compared with sinus rhythm. Hence, a special effort should be made to correct arrhythmia during surgery, and in case of paroxysmal arrhythmia, earlier surgery should be considered before the condition becomes chronic.
二尖瓣疾病与心房颤动（AF）之间的关联已广为人知，但关于二尖瓣置换术（MVR）后AF对纽约心脏协会（NYHA）心功能分级、心房大小和血流动力学参数的影响的数据却很少。本研究旨在评估这些问题。
对86例行MVR的患者（26例男性，60例女性）进行经胸超声心动图检查。59例患者患有慢性AF（AF组），27例为窦性心律（窦性组）。分析的变量包括收缩末期左心房和右心房面积、三尖瓣反流以及AF的存在和持续时间。通过多普勒超声心动图估计人工二尖瓣峰值和平均压差以及肺动脉压力。
两组在年龄、性别和MVR后的时间（平均6.6年）方面相匹配。64例患者（77%）患有风湿性心脏病，18例（21%）患有二尖瓣疾病，2例（2%）患有二尖瓣脱垂。AF的平均持续时间为11±12年（范围：8 - 50年）。术前，AF患者的心功能NYHA分级比窦性患者差（2.8±0.8对1.1±0.7，p = 0.001），但两者左心室缩短分数相似且人工二尖瓣功能良好。多因素分析确定AF是MVR后NYHA分级的唯一预测因素。尽管AF患者的左、右心房面积较大（分别为47±25对27±7 cm²，p = 0.0001和30±12对17±5 cm²，p = 0.0001），但两组之间左、右心房大小比值无显著差异。多因素分析确定人工二尖瓣平均压差和AF持续时间是MVR后左心房大小的独立预测因素（分别为p = 0.01和p = 0.0001）。三尖瓣反流和AF持续时间是右心房大小的独立预测因素（分别为p = 0.003和p = 0.0001）。
与窦性心律相比,MVR后AF的存在与更差的NYHA心功能分级、更高的人工二尖瓣压差以及更大的双侧心房面积相关。因此，手术期间应特别努力纠正心律失常，对于阵发性心律失常患者，应在病情变为慢性之前考虑更早进行手术。
