Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, People's Republic of China
Am J Cardiol. 2010 Mar 1;105(5):709-15. doi: 10.1016/j.amjcard.2009.10.052.
Echocardiograms and left ventricular (LV) filling pressure were obtained from 95 patients with chronic severe mitral regurgitation (MR) and 16 patients with acute severe MR. All patients underwent catheterization for preoperative examinations and LV filling pressure measurements. A total of 52 age-, gender- and co-morbidity-matched patients with negative coronary angiographic results served as the controls. Echocardiography, including assessment of left atrial (LA) distensibility, was performed simultaneously. LA distensibility correlated logarithmically with the LV filling pressure. However, the early-diastolic mitral inflow velocity divided by the early-diastolic mitral annular velocity (mitral E/E') correlated linearly with the LV filling pressure. Bivariate correlation analysis revealed that LV filling pressure correlated positively with the maximum and minimum indexed LA volume, as well as the E/E', but the LV filling pressure correlated negatively with LA distensibility, LA ejection fraction, and LV ejection fraction. However, the MR regurgitation volume was associated only with the maximum and minimum indexed LA volume. Receiver operating characteristic curve analysis indicated that LA distensibility was not inferior to E/E' for identifying a LV filling pressure >15 mm Hg. However, to identify acute severe MR, LA distensibility was superior to E/E'. In conclusion, LA distensibility, as is E/E', is a valuable diastolic parameter. In patients with severe MR, it offers adequate power to assess the LV filling pressure and to identify acute severe MR.
对 95 例慢性重度二尖瓣反流（MR）患者和 16 例急性重度 MR 患者进行了超声心动图和左心室（LV）充盈压检查。所有患者均接受了术前检查和 LV 充盈压测量的导管插入术。共有 52 名年龄、性别和合并症相匹配的冠状动脉造影结果为阴性的患者作为对照组。同时进行了超声心动图检查，包括左心房（LA）顺应性评估。LA 顺应性与 LV 充盈压呈对数相关。然而，二尖瓣舒张早期血流速度与二尖瓣环舒张早期速度之比（二尖瓣 E/E'）与 LV 充盈压呈线性相关。双变量相关分析显示，LV 充盈压与最大和最小指数化 LA 容积以及 E/E'呈正相关，但与 LA 顺应性、LA 射血分数和 LV 射血分数呈负相关。然而，MR 反流容积仅与最大和最小指数化 LA 容积相关。受试者工作特征曲线分析表明，LA 顺应性在识别 LV 充盈压>15mmHg 方面并不逊于 E/E'。然而，要识别急性重度 MR，LA 顺应性优于 E/E'。总之，LA 顺应性与 E/E'一样，是一种有价值的舒张参数。在重度 MR 患者中，它具有足够的能力来评估 LV 充盈压并识别急性重度 MR。
