主动脉瓣置换术后主动脉瓣狭窄患者心肌代谢和舒张功能：患者-假体不匹配的影响。

Myocardial metabolism and diastolic function after aortic valve replacement for aortic stenosis: influence of patient-prosthesis mismatch.

机构信息

Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.

出版信息

Eur J Cardiothorac Surg. 2012 Feb;41(2):316-21. doi: 10.1016/j.ejcts.2011.05.039. Epub 2011 Dec 12.

DOI:10.1016/j.ejcts.2011.05.039

PMID:21737296

Abstract

OBJECTIVE

This study evaluated the impact of patient-prosthesis mismatch on myocardial function and high-energy phosphate metabolism after aortic valve replacement for pure aortic stenosis. Patients with and without patient-prosthesis mismatch were compared using magnetic resonance techniques.

METHODS

Thirty patients who had undergone aortic valve replacement with Medtronic Mosaic bioprosthesis were evaluated. Fifteen patients with patient-prosthesis mismatch were compared to 15 matched patients without patient-prosthesis mismatch. These two homogeneous groups were studied for myocardial metabolism and left ventricle function preoperatively and at 12 months postoperatively with magnetic resonance imaging and (31)P spectroscopy.

RESULTS

All patients experienced improvement in myocardial metabolism and left ventricle function. Left ventricle mass regression was impaired in both groups. Impaired diastolic filling was associated with increased left ventricle wall mass in both groups (patient-prosthesis mismatch: R(2) = -0.71, p = 0.002; no patient-prosthesis mismatch: R(2) = -0.88, p < 0.001). Myocardial phosphocreatine/adenosine triphosphate ratio revealed a modest correlation with left ventricle function as evaluated by early acceleration peak (patient-prosthesis mismatch: R(2) = 0.37, p = 0.03; no patient-prosthesis mismatch: R(2) = 0.17, p = 0.02) and early deceleration peak (patient-prosthesis mismatch: R(2) = 0.30, p = 0.01; no patient-prosthesis mismatch: R(2) = 0.39, p = 0.008). No significant correlation between the phosphocreatine/adenosine triphosphate ratio and left ventricle mass was found (patient-prosthesis mismatch: R(2) = 0.39, p = 0.6; no patient-prosthesis mismatch: R(2) = 0.40, p = 0.08).

CONCLUSION

Aortic valve replacement leads to early improvement of left ventricle function and myocardial metabolism in all patients regardless of the occurrence of patient-prosthesis mismatch.

摘要

目的

本研究评估了主动脉瓣置换术治疗单纯主动脉瓣狭窄患者中患者-假体不匹配对心肌功能和高能磷酸代谢的影响。使用磁共振技术比较了有和没有患者-假体不匹配的患者。

方法

评估了 30 名接受美敦力马赛克生物瓣主动脉瓣置换术的患者。15 名患者存在患者-假体不匹配，与 15 名匹配的无患者-假体不匹配患者进行比较。这两组同质患者在术前和术后 12 个月分别使用磁共振成像和（31）P 光谱进行心肌代谢和左心室功能研究。

结果

所有患者的心肌代谢和左心室功能均得到改善。两组的左心室质量回归均受损。两组舒张功能不全均与左心室壁质量增加相关（患者-假体不匹配：R² = -0.71，p = 0.002；无患者-假体不匹配：R² = -0.88，p < 0.001）。心肌磷酸肌酸/三磷酸腺苷比值与早期加速峰值（患者-假体不匹配：R² = 0.37，p = 0.03；无患者-假体不匹配：R² = 0.17，p = 0.02）和早期减速峰值（患者-假体不匹配：R² = 0.30，p = 0.01；无患者-假体不匹配：R² = 0.39，p = 0.008）评估的左心室功能呈中度相关。磷酸肌酸/三磷酸腺苷比值与左心室质量之间无显著相关性（患者-假体不匹配：R² = 0.39，p = 0.6；无患者-假体不匹配：R² = 0.40，p = 0.08）。