Guven Saadet, Sen Taner, Tufekcioglu Omac, Gucuk Esra, Uygur Belma, Kahraman Erkan
Department of Cardiology, Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Turkey.
Cardiol J. 2014;21(1):33-8. doi: 10.5603/CJ.a2013.0058. Epub 2013 Jun 25.
Mitral stenosis (MS) is still the most common complication of acute rheumatic fever in Turkey. Rheumatic carditis affects not only cardiac valves but also myocardium. In this study, we aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction and contraction of short and long axial circumferential and longitudinal fibers by pulsed wave tissue Doppler in rheumatic MS patients who have preserved LV systolic function in 2D echocardiography.
Fifteen severe, 20 moderate rheumatic MS patients hospitalized for mitral balloon valvuloplasty, and 15 patients who had normal echocardiographic findings were included in the study. After routine conventional transthoracic echocardiographic examination, LV myocardial systolic velocities were evaluated with pulsed wave tissue Doppler in the short and long axis with simultaneous electrocardiographic monitoring.
Long axis first systolic velocity (SW1) of mild-moderate and severe MS was much lower than normal group (10.7 ± 2.3 in normal group vs. 7.9 ± 1.3 in mild-moderate MS group vs. 6.2 ± 1.4 in severe MS group, p < 0.001). Long axis Q-SW1 duration was longer in mild-moderate MS group (145 ± 32 in normal group vs. 199 ± 43 in mild-moderate MS group, p = 0.001). Short axis Q-SW2 duration was longer in normal group compared to mild-moderate and severe MS groups (298 ± 41 in normal group vs. 245 ± 37 in mild-moderate MS group vs. 234 ± 26 in severe MS group, p < 0.001). Significant correlation between mitral valve area and SW1, Q-SW1 was determined (p = 0.01).
Even if LV functions are normal with conventional 2D echocardiography, subclinical systolic dysfunction exists in MS. Also, there is a dyssynchrony between contraction of longitudinal and circumferential myofibrils.
在土耳其，二尖瓣狭窄（MS）仍是急性风湿热最常见的并发症。风湿性心脏炎不仅影响心脏瓣膜，还会累及心肌。在本研究中，我们旨在通过脉冲波组织多普勒评估二维超声心动图显示左心室（LV）收缩功能正常的风湿性MS患者的亚临床左心室收缩功能障碍以及短轴和长轴圆周及纵向纤维的收缩情况。
本研究纳入了15例因二尖瓣球囊瓣膜成形术住院的重度、20例中度风湿性MS患者，以及15例超声心动图检查结果正常的患者。在进行常规经胸超声心动图检查后，通过脉冲波组织多普勒在短轴和长轴上同步进行心电图监测，评估左心室心肌收缩速度。
轻中度和重度MS患者的长轴首次收缩速度（SW1）远低于正常组（正常组为10.7±2.3，轻中度MS组为7.9±1.3，重度MS组为6.2±1.4，p<0.001）。轻中度MS组长轴Q-SW1持续时间更长（正常组为145±32，轻中度MS组为199±43，p=0.001）。与轻中度和重度MS组相比，正常组短轴Q-SW2持续时间更长（正常组为298±41，轻中度MS组为245±37，重度MS组为234±26，p<0.001）。二尖瓣面积与SW1、Q-SW1之间存在显著相关性（p=0.01）。
即使常规二维超声心动图显示左心室功能正常，MS患者仍存在亚临床收缩功能障碍。此外，纵向和圆周肌原纤维的收缩之间存在不同步。
