Porciani Maria Cristina, Macioce Roberto, Demarchi Gabriele, Chiostri Marco, Musilli Nicola, Cappelli Francesco, Lilli Alessio, Ricciardi Giuseppe, Padeletti Luigi
University of Florence, Institute of Internal Medicine and Cardiology, V. le Morgagni 85, 50134 Florence, Italy.
Eur J Echocardiogr. 2006 Jan;7(1):31-9. doi: 10.1016/j.euje.2005.03.008.
Functional mitral regurgitation (FMR) improvement induced by cardiac resynchronization therapy (CRT) has been related to left ventricular (LV) remodeling reversal and contractility enhancement. The effects induced by the changes of LV synchronicity indexes on FMR severity have not been investigated.
In 30 patients with CRT for heart failure (HF) and QRS>130 ms, LV function parameters, FMR severity as mitral jet regurgitation/left atrial area ratio (JA/LAA) and standard deviation (SD) of the time to the systolic peak velocity at 6-basal and mid-LV segments as asynchrony indexes were evaluated (echo/tissue Doppler) before and 6 months after implant. At follow-up, 15 patients resulted responders to LV reverse remodeling with > or =15% end-systolic volume (ESV) and LV systolic function improvement. Improvement of FMR with > or =15% JA/LAA reduction was observed in 19 patients, 7 were nonresponders to LV reverse remodeling. In patients with > or =15% JA/LAA reduction a significant decrease of LV asynchrony indexes was observed as compared to patients without > or =15% JA/LAA reduction in whom LV asynchrony indexes were increased. Reduction of LV mid-segmental asynchrony was the variable most strongly related to JA/LAA reduction (r(2)=0.697, P<0.01), with good agreement between observed and predicted values (only 1 patient outside the mean+/-2SD).
These data reveal that CRT can reduce FMR irrespective to LV remodeling reversal; this effect is related to LV asynchrony reduction and further support CRT employment in patients with HF and FMR.
心脏再同步治疗（CRT）所诱导的功能性二尖瓣反流（FMR）改善与左心室（LV）重构逆转和收缩力增强有关。LV同步性指标变化对FMR严重程度的影响尚未得到研究。
在30例接受CRT治疗心力衰竭（HF）且QRS>130 ms的患者中，在植入前及植入后6个月评估LV功能参数、作为二尖瓣反流/左心房面积比（JA/LAA）的FMR严重程度以及6个LV基底段和中段至收缩期峰值速度时间的标准差（SD）作为不同步指标（超声心动图/组织多普勒）。随访时，15例患者出现LV逆向重构反应，左室收缩末期容积（ESV）减少≥15%且LV收缩功能改善。19例患者观察到FMR改善，JA/LAA降低≥15%，7例对LV逆向重构无反应。与JA/LAA降低未达到≥15%且LV不同步指标增加的患者相比，JA/LAA降低≥15%的患者LV不同步指标显著降低。LV中段不同步性降低是与JA/LAA降低最密切相关的变量（r² = 0.697，P<0.01），观察值与预测值之间具有良好的一致性（仅1例患者超出均值±2SD）。
这些数据表明，CRT可降低FMR，而与LV重构逆转无关；这种效应与LV不同步性降低有关，并进一步支持在HF和FMR患者中应用CRT。
