缺血性与特发性扩张型心肌病中功能性二尖瓣反流的超声心动图特征差异：一项初步研究。

Differences in echocardiographic characteristics of functional mitral regurgitation in ischaemic versus idiopathic dilated cardiomyopathy: a pilot study.

作者信息

Papadopoulou Klio, Giannakoulas Georgios, Karvounis Haralambos, Dalamanga Emmanouella, Karamitsos Theodoros, Parcharidou Despina, Damvopoulou Efthalia, Efthimiadis Georgios K, Styliadis Ioannis, Parcharidis Georgios

机构信息

AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

出版信息

Hellenic J Cardiol. 2009 Jan-Feb;50(1):37-44.

DOI:

PMID:19196619

Abstract

INTRODUCTION

Functional mitral regurgitation (FMR) is a common complication in patients with ischaemic (ICM) or idiopathic dilated cardiomyopathy (DCM), as a consequence of left ventricular (LV) remodelling. The aim of this study was to elucidate the differences in FMR between patients with ICM and DCM utilising conventional and tissue Doppler echocardiography.

METHODS

We studied 21 patients with ICM and 17 with DCM using conventional and tissue Doppler echocardiography. The severity of FMR was assessed quantitatively and by the PISA method. The 2 groups were similar in terms of NYHA class, LV ejection fraction and pharmacological treatment.

RESULTS

Patients with ICM had higher pulmonary artery systolic pressures (48 +/- 16 vs. 38 +/- 10 mmHg, p=0.04), more severe FMR as assessed by colour Doppler (1.9 +/- 0.9 vs. 1.1 +/- 0.5, p=0.006), and a larger effective regurgitant orifice (0.17 +/- 0.07 vs. 0.1 +/- 0.05 cm(2), p=0.003) and tenting area (2.3 +/- 0.8 vs. 1.7 +/- 0.7 cm(2), p=0.02). In addition, ICM subjects had lower mitral annular systolic (Sm 2.3 +/- 0.8 vs. 3.4 +/- 0.9 cm/s, p<0.001) and diastolic (Em 2.5 +/- 1 vs. 3.8 +/- 1.5 cm/s, p=0.005; Am 3.1 +/- 1.4 vs. 4.3 +/- 1.7 cm/s, p=0.02) myocardial velocities, and a higher ratio of early transmitral filling velocity to early mitral annular diastolic velocity (LV E/Em 42 +/- 29 vs. 22.7 +/- 7.6, p=0.008) compared to DCM patients. Systolic and diastolic mitral annular velocities were significantly correlated with effective regurgitant orifice. Tenting area >1.27 cm(2) exhibited the highest sensitivity and regurgitant volume >24 ml the highest specificity for predicting ischaemic aetiology of LV dysfunction. However, only age and Sm were independent predictors of the diagnosis of ICM rather than DCM.

CONCLUSIONS

Mitral apparatus deformity, incomplete closure of mitral leaflets and global remodelling are more prominent in patients with ICM and lead to more severe FMR than in patients with DCM.

摘要

引言

功能性二尖瓣反流（FMR）是缺血性心肌病（ICM）或特发性扩张型心肌病（DCM）患者常见的并发症，是左心室（LV）重塑的结果。本研究的目的是利用传统和组织多普勒超声心动图阐明ICM和DCM患者FMR的差异。

方法

我们使用传统和组织多普勒超声心动图研究了21例ICM患者和17例DCM患者。通过定量和PISA方法评估FMR的严重程度。两组在纽约心脏协会（NYHA）分级、左心室射血分数和药物治疗方面相似。

结果

ICM患者的肺动脉收缩压更高（48±16 vs. 38±10 mmHg，p = 0.04），经彩色多普勒评估的FMR更严重（1.9±0.9 vs. 1.1±0.5，p = 0.006），有效反流口更大（0.17±0.07 vs. 0.1±0.05 cm²，p = 0.003）和帐篷面积更大（2.3±0.8 vs. 1.7±0.7 cm²，p = 0.02）。此外，与DCM患者相比，ICM患者的二尖瓣环收缩期（Sm 2.3±0.8 vs. 3.4±0.9 cm/s，p<0.001）和舒张期（Em 2.5±1 vs. 3.8±1.5 cm/s，p = 0.005；Am 3.1±1.4 vs. 4.3±1.7 cm/s，p = 0.02）心肌速度更低，早期二尖瓣血流速度与早期二尖瓣环舒张期速度之比更高（LV E/Em 42±29 vs. 22.7±7.6，p = 0.008）。收缩期和舒张期二尖瓣环速度与有效反流口显著相关。帐篷面积>1.27 cm²对预测左心室功能障碍的缺血病因敏感性最高，反流容积>24 ml特异性最高。然而，只有年龄和Sm是ICM而非DCM诊断的独立预测因素。