Chrustowicz Anton, Gackowski Andrzej, El-Massri Nader, Sadowski Jerzy, Piwowarska Wiesława
Department of the Coronary Disease, Institute of Cardiology, Krakow, Poland.
Echocardiography. 2010 Mar;27(3):282-5. doi: 10.1111/j.1540-8175.2009.01001.x. Epub 2009 Dec 16.
To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters.
RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 +/- 10 years). Mean NYHA class was 2.6 +/- 0.4, LVEF was 55.3 +/- 12%, RV end-diastolic diameter was 28.7 +/- 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 +/- 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 +/- 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing.
Mean preoperative TAPSE and Sa were 19.4 +/- 4.3 mm and 10.3 +/- 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end-diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 +/- 2 cm/sec (P < 0.001), and TAPSE 8.7 +/- 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point.
The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR.
评估重度二尖瓣反流（MR）患者的右心室（RV）功能；寻找术前和术后参数之间的关系。
通过测定45例重度器质性MR患者（男性占53.3%，年龄58±10岁）的三尖瓣环平面收缩期位移（TAPSE）和三尖瓣环外侧的收缩期峰值速度（Sa），以超声心动图评估RV功能。平均纽约心脏协会（NYHA）分级为2.6±0.4，左心室射血分数（LVEF）为55.3±12%，RV舒张末期直径为28.7±4.7，左心室收缩末期直径（LVESD）为44.6±12.6mm, 左心室舒张末期容积（Simpson法）为160.6±50.3ml。所有患者均接受保留后叶腱索的二尖瓣置换术。
术前平均TAPSE和Sa分别为19.4±4.3mm和10.3±3cm/秒。RV功能障碍定义为TAPSE<22mm，66.6%的患者存在该情况，术前62.2%的患者Sa<11cm/秒。术前TAPSE和Sa显著相关（P<0.00001，r=0.61）。TAPSE和Sa均与RV舒张末期直径（P<0.01）、LVESD（P<0.05）、左心室dp/dt（P<0.05）和LVEF（P<0.0001）相关。术后LVEF为50%（P<0.001），Sa为5.3±2cm/秒（P<0.001），TAPSE为8.7±3.2mm（P<0.001）。21例患者（46.6%）达到LVEF下降超过10%的研究终点。单因素预测指标为年龄（P=0.04）、男性（P=0.01）、TAPSE（P=0.007）和Sa（P=0.009），而反流分数（P=0.058）和左心室舒张末期容积指数（P=0.09）有相关趋势。多因素分析显示，TAPSE（P=0.01）和Sa（P=0.01）可预测研究终点。
超声心动图评估RV功能是一种简单的工具，可为MR患者提供预后信息。
