Sade Leyla Elif, Ozin Bülent, Ulus Taner, Açikel Sadik, Pirat Bahar, Bilgi Muhammed, Uluçam Melek, Müderrisoğlu Haldun
University of Başkent, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
Int J Cardiol. 2009 Jun 26;135(2):193-201. doi: 10.1016/j.ijcard.2008.03.050. Epub 2008 Jul 14.
We investigated whether isovolumic acceleration (IVA) under inotropic stimulation as a means of right ventricular (RV) contractile reserve, is a surrogate for hemodynamic burden and has prognostic value in patients with mitral stenosis (MS).
Thirty-one pure MS patients and 20 controls underwent cardiac catheterization, exercise test, and dobutamine stress echocardiography. RV fractional area change (FAC), +dP/dt/P(max), RV tissue Doppler indices (isovolumic contraction [IVC] and systolic [S] velocity, and IVA) were measured. Patients were followed-up for the occurrence of cardiac adverse events.
Inotropic modulation unmasked statistically significant differences regarding magnitude of changes in IVA, IVC, S, and +dP/dt/P(max), but not RV FAC. Inability to increase IVA more than 6.5 m/s(2) was the only independent determinant of pulmonary capillary wedge pressure >or=18 mm Hg (P=.004). Although MS severity did not predict the RV contractile reserve and pulmonary artery pressure (PAP) behavior during inotropic stimulation, the RV contractile reserve was related to the degree of systolic PAP. IVA increases of <3.4 m/s(2) had 86% sensitivity and 75% specificity to predict unfavorable outcomes during long-term follow-up (20+/-8 months).
RV contractile reserve provides complementary data to the hemodynamic significance of MS severity, may contribute to clinical decision making, and be of prognostic value in these patients.
我们研究了在正性肌力刺激下等容加速（IVA）作为右心室（RV）收缩储备的一种手段，是否是血流动力学负担的替代指标以及对二尖瓣狭窄（MS）患者是否具有预后价值。
31例单纯MS患者和20例对照者接受了心导管检查、运动试验和多巴酚丁胺负荷超声心动图检查。测量了RV面积变化分数（FAC）、+dP/dt/P(max)、RV组织多普勒指标（等容收缩期[IVC]和收缩期[S]速度以及IVA）。对患者进行心脏不良事件发生情况的随访。
正性肌力调节揭示了IVA、IVC、S和+dP/dt/P(max)变化幅度方面具有统计学意义的差异，但RV FAC无差异。IVA增加幅度不能超过6.5 m/s(2)是肺毛细血管楔压≥18 mmHg的唯一独立决定因素（P = 0.004）。虽然MS严重程度不能预测正性肌力刺激期间的RV收缩储备和肺动脉压（PAP）变化，但RV收缩储备与收缩期PAP程度相关。IVA增加幅度<3.4 m/s(2)对预测长期随访（20±8个月）期间的不良结局具有86%的敏感性和75%的特异性。
RV收缩储备为MS严重程度的血流动力学意义提供了补充数据，可能有助于临床决策，并对这些患者具有预后价值。
