二尖瓣瓣叶闭合点与二尖瓣环平面之间距离增加：心力衰竭患者中的意义及相关性

Increased distance between mitral valve coaptation point and mitral annular plane: significance and correlations in patients with heart failure.

作者信息

Karagiannis S E, Karatasakis G T, Koutsogiannis N, Athanasopoulos G D, Cokkinos D V

机构信息

First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece.

出版信息

Heart. 2003 Oct;89(10):1174-8. doi: 10.1136/heart.89.10.1174.

DOI:10.1136/heart.89.10.1174

PMID:12975411

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1767909/

Abstract

OBJECTIVE

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.

DESIGN

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.

SETTING

Tertiary referral centre.

PATIENTS

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.

INTERVENTIONS

A dobutamine infusion was given in 18 patients and preload increase by leg lifting in 28.

MAIN OUTCOME MEASURES

Correlations between CPMA and contractility indices at baseline and during interventions.

RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

设计

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。

地点

三级转诊中心。

患者

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。

干预措施

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。

主要观察指标

基线时及干预过程中CPMA与收缩性指标之间的相关性。

结果

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。