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原发性二尖瓣反流对左心室同步性的影响。

Effect of primary mitral regurgitation on left ventricular synchrony.

作者信息

Denney Thomas S, Nagaraj Hosakote M, Lloyd Steven G, Aban Inmaculada, Corros Cecilia, Seghatol-Eslami Frank, McGiffin David C, Dell'Italia Louis J, Gupta Himanshu

机构信息

Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama, USA.

出版信息

Am J Cardiol. 2007 Aug 15;100(4):707-11. doi: 10.1016/j.amjcard.2007.03.088. Epub 2007 Jun 21.

Abstract

Mitral regurgitation (MR) promotes left ventricular (LV) dilatation and eccentric remodeling. In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderate to severe primary MR causes LV dyssynchrony in the presence of LV dilation and an ejection fraction (EF) >55%. We studied 37 normal subjects and 22 patients with moderate to severe MR and no coronary artery disease. Electrocardiographically gated cine and tagged cardiac magnetic resonance imaging was performed. Two-dimensional, maximum-circumferential shortening strain and time-to-peak strain (TTPS) were computed using harmonic-phase analysis of tagged magnetic resonance imaging. LV dyssynchrony was assessed by comparing TTPS delay of various LV quadrants and TTPS dispersion among the contralateral quadrants in patients with MR and normal subjects. Statistical comparison was done using a generalized linear model for repeated measurements. LV end-diastolic and LV end-systolic volumes were significantly larger in patients with MR versus normal subjects (207 +/- 11 vs 130 +/- 4 and 73 +/- 5 vs 47 +/- 2 ml, p <0.001). LVEF did not differ in patients with MR and normal subjects. The difference in the TTPS among various quadrants and the dispersion among the contralateral quadrants of the LV myocardium was similar between patients with MR and normal subjects. In conclusion, moderate to severe MR does not cause LV dyssynchrony in patients with LV dilatation and normal LVEF. Thus, cardiac resynchronization therapy in the absence of LV dyssynchrony may not decrease the severity of MR.

摘要

二尖瓣反流(MR)会促进左心室(LV)扩张和离心性重塑。在存在左心室不同步和心力衰竭的情况下,心脏再同步治疗可降低二尖瓣反流的严重程度。原发性二尖瓣反流是否会导致左心室不同步尚不清楚。我们研究了在左心室扩张且射血分数(EF)>55%的情况下,中度至重度原发性二尖瓣反流是否会导致左心室不同步。我们研究了37名正常受试者和22名患有中度至重度二尖瓣反流且无冠状动脉疾病的患者。进行了心电图门控电影和标记心脏磁共振成像。使用标记磁共振成像的谐波相位分析计算二维、最大圆周缩短应变和峰值应变时间(TTPS)。通过比较二尖瓣反流患者和正常受试者不同左心室象限的TTPS延迟以及对侧象限之间的TTPS离散度来评估左心室不同步。使用广义线性模型进行重复测量的统计比较。与正常受试者相比,二尖瓣反流患者的左心室舒张末期和收缩末期容积明显更大(207±11 vs 130±4以及73±5 vs 47±2 ml,p<0.001)。二尖瓣反流患者和正常受试者的左心室射血分数没有差异。二尖瓣反流患者和正常受试者之间,左心室心肌不同象限之间的TTPS差异以及对侧象限之间的离散度相似。总之,在左心室扩张且左心室射血分数正常的患者中,中度至重度二尖瓣反流不会导致左心室不同步。因此,在不存在左心室不同步的情况下进行心脏再同步治疗可能不会降低二尖瓣反流的严重程度。

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