Karagiannis S E, Karatasakis G T, Koutsogiannis N, Athanasopoulos G D, Cokkinos D V
First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece.
Heart. 2003 Oct;89(10):1174-8. doi: 10.1136/heart.89.10.1174.
To measure the distance between the mitral leaflet coaptation point and the mitral annulus (CPMA) and assess the relation of this index to structural and functional characteristics of the failing left ventricle.
Echocardiographic indices and CPMA were measured at baseline and again during dobutamine infusion and leg lifting. Left ventricular diastolic and systolic dimensions, left ventricular ejection fraction (LVEF) by Simpson's rule, mitral annulus dimension, and E point septal separation were correlated with CPMA.
Tertiary referral centre.
The total study population of 129 patients included 94 with LVEF < 35% and 35 with LVEF 35%-45%; 76 had coronary artery disease and 53 had dilated cardiomyopathy.
A dobutamine infusion was given in 18 patients and preload increase by leg lifting in 28.
Correlations between CPMA and contractility indices at baseline and during interventions.
CPMA was correlated with left ventricular diastolic dimension (r = 0.52), left ventricular systolic dimension (r = 0.53), LVEF (r = -0.44), fractional shortening (r = -0.42), E point septal separation (r = 0.48), and mitral annulus dimension (r = 0.44) (all p < 0.001). Dobutamine decreased CPMA from (mean (SD)) 12.04 (3.64) mm to 8.92 (2.56) mm and increased LVEF from 27 (6.2)% at baseline to 33.4 (6.9)% at 10 microg/kg/min (both p < 0.001). These changes were strongly related (r = 0.68, p < 0.007). After leg lifting, CPMA decreased from 13 (4) mm at baseline to 10 (3) mm (p < 0.001), and LVEF increased from 32 (11)% at baseline to 39 (11)% (p < 0.001). Fractional shortening and left ventricular diastolic dimension also increased (p < 0.001) and mitral annulus dimension and E point septal separation decreased (p < 0.002), but left ventricular systolic dimension did not change.
The mechanism displacing the mitral coaptation point towards the left ventricular apex is multifactorial. The correlations between CPMA difference (before versus after interventions) and ejection fraction difference (before versus after interventions) shows that this index depends mainly on left ventricular function.
测量二尖瓣瓣叶闭合点与二尖瓣环之间的距离（CPMA），并评估该指标与衰竭左心室结构和功能特征的关系。
在基线时以及多巴酚丁胺输注和抬腿过程中再次测量超声心动图指标和CPMA。左心室舒张和收缩内径、通过Simpson法则测得的左心室射血分数（LVEF）、二尖瓣环内径以及E点至室间隔距离与CPMA相关。
三级转诊中心。
129例患者的总研究人群包括94例LVEF<35%的患者和35例LVEF为35%-45%的患者；76例患有冠状动脉疾病，53例患有扩张型心肌病。
18例患者接受多巴酚丁胺输注，28例患者通过抬腿增加前负荷。
基线时及干预过程中CPMA与收缩性指标之间的相关性。
CPMA与左心室舒张内径（r = 0.52）、左心室收缩内径（r = 0.53）、LVEF（r = -0.44）、缩短分数（r = -0.42）、E点至室间隔距离（r = 0.48）以及二尖瓣环内径（r = 0.44）相关（均p<0.001）。多巴酚丁胺使CPMA从（均值（标准差））12.04（3.64）mm降至8.92（2.56）mm，并使LVEF从基线时的27（6.2）%增加至10μg/kg/min时的33.4（6.9）%（均p<0.001）。这些变化密切相关（r = 0.68，p<0.007）。抬腿后，CPMA从基线时的13（4）mm降至10（3）mm（p<0.001），LVEF从基线时的32（11）%增加至从39（11）%（p<0.001）。缩短分数和左心室舒张内径也增加（p<0.001），二尖瓣环内径和E点至室间隔距离减小（p<0.002），但左心室收缩内径未改变。
使二尖瓣闭合点向左心室心尖移位的机制是多因素的。CPMA差值（干预前与干预后）与射血分数差值（干预前与干预后）之间的相关性表明，该指标主要取决于左心室功能。
