Vijayalakshmi I B, Yavagal S T, Prabhudev N
Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India.
Echocardiography. 2005 Apr;22(4):289-95. doi: 10.1111/j.1540-8175.2005.04051.x.
The objectives of this article are to determine the possible mechanism of functional mitral regurgitation in patients with dilated cardiomyopathy (DCM) and to know the effect of ramipril on left ventricle (LV) and mitral regurgitation by ECHO. Several postulates are put forth for functional mitral regurgitation in DCM, and mitral annular dilatation is said to be the primary mechanism in the past, but the exact mechanism is not clear. Though angiotensin converting enzyme (ACE) inhibitors are known to remodel the LV, their beneficial effect in patients with DCM with functional mitral regurgitation is not known. Various cardiac dimensions and degree of mitral regurgitation were measured by echocardiography in 30 normal control group and in 30 patients with DCM of various etiologies except ischemic, before and after ramipril therapy. There was a significant difference in all parameters especially sphericity of left ventricle and position of papillary muscles (P < 0.0003) in DCM patients, but mitral valve annulus did not show significant change (P < 0.3) compared to control group. In 50% of the patients, the functional mitral regurgitation totally disappeared. In 30% of patients, it came down from grade II to I or became trivial. In 20% of patients, it remained unchanged. There was remarkable improvement in sphericity, LV dimension, volumes, and EF%, which increased from 31 +/- 9.81 to 39.3 +/- 8.3% (P < 0.0003). It is concluded that echocardiography clearly demonstrates the increased sphericity of LV in DCM. The lateral migration of papillary muscles possibly plays a major role in functional mitral regurgitation. Ramipril significantly reduces not only sphericity but also functional mitral regurgitation.
本文的目的是确定扩张型心肌病（DCM）患者功能性二尖瓣反流的可能机制，并通过超声心动图了解雷米普利对左心室（LV）和二尖瓣反流的影响。关于DCM中功能性二尖瓣反流提出了几种假设，过去认为二尖瓣环扩张是主要机制，但确切机制尚不清楚。尽管已知血管紧张素转换酶（ACE）抑制剂可使左心室重塑，但其对伴有功能性二尖瓣反流的DCM患者的有益作用尚不清楚。在30例正常对照组和30例除缺血性外各种病因的DCM患者中，在雷米普利治疗前后通过超声心动图测量了各种心脏尺寸和二尖瓣反流程度。DCM患者的所有参数，尤其是左心室的球形度和乳头肌位置，均有显著差异（P < 0.0003），但与对照组相比，二尖瓣环未显示出显著变化（P < 0.3）。50%的患者功能性二尖瓣反流完全消失。30%的患者反流程度从II级降至I级或变为轻微反流。20%的患者反流程度保持不变。球形度、左心室尺寸、容积和射血分数（EF%）有显著改善，EF%从31±9.81%增至39.3±8.3%（P < 0.0003）。结论是，超声心动图清楚地显示了DCM患者左心室球形度增加。乳头肌的侧向移位可能在功能性二尖瓣反流中起主要作用。雷米普利不仅能显著降低球形度，还能显著减轻功能性二尖瓣反流。
