Division of Cardiology, Department of Medicine, St, Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.
J Cardiovasc Magn Reson. 2010 May 24;12(1):32. doi: 10.1186/1532-429X-12-32.
BACKGROUND: The treatment of patients with aortic regurgitation (AR) or mitral regurgitation (MR) relies on the accurate assessment of the severity of the regurgitation as well as its effect on left ventricular (LV) size and function. Cardiovascular Magnetic Resonance (CMR) is an excellent tool for quantifying regurgitant volumes as well as LV size and function. The 2008 AHA/ACC management guidelines for the therapy of patients with AR or MR only describe LV size in terms of linear dimensions (i.e. end-diastolic and end-systolic dimension). LV volumes that correspond to these linear dimensions have not been published in the peer-reviewed literature. The purpose of this study is to determine the effect of regurgitant volume on LV volumes and chamber dimensions in patients with isolated AR or MR and preserved LV function. METHODS: Regurgitant volume, LV volume, mass, linear dimensions, and ejection fraction, were determined in 34 consecutive patients with isolated AR and 23 consecutive patients with MR and no other known cardiac disease. RESULTS: There is a strong, linear relationship between regurgitant volume and LV end-diastolic volume index (aortic regurgitation r2 = 0.8, mitral regurgitation r2 = 0.8). Bland-Altman analysis of regurgitant volume shows little interobserver variation (AR: 0.6 +/- 4 ml; MR 4 +/- 6 ml). The correlation is much poorer between regurgitant volume and commonly used clinical linear measures such as end-systolic dimension (mitral regurgitation r2 = 0.3, aortic regurgitation r2 = 0.5). For a given regurgitant volume, AR causes greater LV enlargement and hypertrophy than MR. CONCLUSION: CMR is an accurate and robust technique for quantifying regurgitant volume in patients with AR or MR. Ventricular volumes show a stronger correlation with regurgitant volume than linear dimensions, suggesting LV volumes better reflect ventricular remodeling in patients with isolated mitral or aortic regurgitation. Ventricular volumes that correspond to published recommended linear dimensions are determined to guide the timing of surgical intervention.
背景：主动脉瓣反流（AR）或二尖瓣反流（MR）患者的治疗依赖于对反流严重程度及其对左心室（LV）大小和功能影响的准确评估。心血管磁共振（CMR）是一种量化反流量以及 LV 大小和功能的极佳工具。2008 年 AHA/ACC 治疗 AR 或 MR 患者的管理指南仅描述了 LV 大小的线性尺寸（即舒张末期和收缩末期尺寸）。与这些线性尺寸相对应的 LV 容积尚未在同行评议的文献中公布。本研究的目的是确定反流量对孤立性 AR 或 MR 且 LV 功能正常患者的 LV 容积和腔室尺寸的影响。
方法：连续纳入 34 例孤立性 AR 和 23 例孤立性 MR 且无其他已知心脏病的患者，测定反流量、LV 容积、质量、线性尺寸和射血分数。
结果：LV 舒张末期容积指数与反流量之间存在很强的线性关系（AR：r2 = 0.8；MR：r2 = 0.8）。反流量的 Bland-Altman 分析显示观察者间差异较小（AR：0.6 ± 4 ml；MR 4 ± 6 ml）。反流量与常用的临床线性测量值（如收缩末期尺寸）之间的相关性较差（MR：r2 = 0.3；AR：r2 = 0.5）。对于给定的反流量，AR 导致 LV 扩大和肥厚程度大于 MR。
结论：CMR 是一种准确且强大的技术，可用于量化 AR 或 MR 患者的反流量。心室容积与反流量的相关性强于线性尺寸，表明在孤立性二尖瓣或主动脉瓣反流患者中，LV 容积更好地反映心室重构。与公布的推荐线性尺寸相对应的心室容积用于指导手术干预的时机。
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